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Akalia,You are on target. You are absolutely correct about the role and the trust that nurses are entrusted with. “The establishment of trust in the registered nurse (RN)–patient relationship promotes patient engagement and improves the likelihood that the patient will be an active member of the patient care team”, (Leslie, & Lonneman, 2016). We are the patient confident, they do complain to us about pain, they do listen to us about medical issues and other issues that we may not have information or related to their illness. Patient’s safety is always at the helm of our patient care, confidentiality, and all patients’ information. As we are with the patients at all times they do come to us with all questions and issues. We the nursing staff and the nursing individuals are trusted even more than their own family. We are patient’s advocates and they inform us as if we were part of their family.ReferencesLeslie, J. L., & Lonneman, W. (2016). Promoting trust in the registered nurse-patient relationship. Home Healthcare Now, 34(1), 38.Manny

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Akalia,You are on target. You are absolutely correct about the role and the trust that nurses are entrusted with. “The establishment of trust in the registered nurse (RN)–patient relationship promotes patient engagement and improves the likelihood that the patient will be an active member of the patient care team”, (Leslie, & Lonneman, 2016). We are the patient confident, they do complain to us about pain, they do listen to us about medical issues and other issues that we may not have information or related to their illness. Patient’s safety is always at the helm of our patient care, confidentiality, and all patients’ information. As we are with the patients at all times they do come to us with all questions and issues. We the nursing staff and the nursing individuals are trusted even more than their own family. We are patient’s advocates and they inform us as if we were part of their family.ReferencesLeslie, J. L., & Lonneman, W. (2016). Promoting trust in the registered nurse-patient relationship. Home Healthcare Now, 34(1), 38.Manny

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Kathye,                       You are absolutely correct about your children and generally about cyber space technology which allows children of all ages to able access into are which they should not. Yes you are correct about parental control in the internet and also at the point when they need to stop being involved in the web of the internet, and ‘return’ to the family fold. Cyberbullying crosses all. “Cyberbullying has become a major international focus of not only young people, educators, and researchers, but also among the general population, owing to high profile cases of cyberbullying victimization involving suicide”, (Brody, & Vangelisti, 2016).ReferencesBrody, N., & Vangelisti, A. L. (2016). Bystander intervention in cyberbullying. Communication Monographs, 83(1), 94-119. doi:10.1080/03637751.2015.1044256   Manny

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Kathye,                       You are absolutely correct about your children and generally about cyber space technology which allows children of all ages to able access into are which they should not. Yes you are correct about parental control in the internet and also at the point when they need to stop being involved in the web of the internet, and ‘return’ to the family fold. Cyberbullying crosses all. “Cyberbullying has become a major international focus of not only young people, educators, and researchers, but also among the general population, owing to high profile cases of cyberbullying victimization involving suicide”, (Brody, & Vangelisti, 2016).ReferencesBrody, N., & Vangelisti, A. L. (2016). Bystander intervention in cyberbullying. Communication Monographs, 83(1), 94-119. doi:10.1080/03637751.2015.1044256   Manny

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Eduardo,Thank you for your perspective and your insight. In the first case the penalty or consequence should have been much stepper and sever with actually imprisonment time. Patient and all individual health care information is a sacred area of nursing and healthcare in general. It is puzzling that the court system took the easy way out. As the information of electronic transmission continues to increase and magnitude, it should become a yearly risk cause analysis that needs to evaluate all aspects of breaking down incidents that may take place. Respecting patient confidentiality is a nurse’s critical issue as it is disseminated among various users. The question that I may ask is, are we facing the end of the concept of confidentiality. The issue of electronic devices used in public and are at risk for divulging information is critical. In one of the organizations that I worked in the past, all information sent out of the office was encrypted and was deactivated after 24 hours on a daily basis.Nursing code and patient responsibility should be above and beyond other area of service sectors. “The Code (Nursing and Midwifery Council (NMC) 2008 ) makes it clear that nurses must 'make the care of people your first concern, treating them as individuals and respecting their dignity', but it also requires the nurse to 'work with others to protect and promote the health and wellbeing of those in your care, their families and careers, and the wider community”, (Price, 2015).ReferencesPrice , B. (2015). Respecting patient confidentiality. Nursing Standard 29(22), 50. doi:http://dx.doi.org/10.7748/ns.29.22.50.e9579

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Eduardo,Thank you for your perspective and your insight. In the first case the penalty or consequence should have been much stepper and sever with actually imprisonment time. Patient and all individual health care information is a sacred area of nursing and healthcare in general. It is puzzling that the court system took the easy way out. As the information of electronic transmission continues to increase and magnitude, it should become a yearly risk cause analysis that needs to evaluate all aspects of breaking down incidents that may take place. Respecting patient confidentiality is a nurse’s critical issue as it is disseminated among various users. The question that I may ask is, are we facing the end of the concept of confidentiality. The issue of electronic devices used in public and are at risk for divulging information is critical. In one of the organizations that I worked in the past, all information sent out of the office was encrypted and was deactivated after 24 hours on a daily basis.Nursing code and patient responsibility should be above and beyond other area of service sectors. “The Code (Nursing and Midwifery Council (NMC) 2008 ) makes it clear that nurses must 'make the care of people your first concern, treating them as individuals and respecting their dignity', but it also requires the nurse to 'work with others to protect and promote the health and wellbeing of those in your care, their families and careers, and the wider community”, (Price, 2015).ReferencesPrice , B. (2015). Respecting patient confidentiality. Nursing Standard 29(22), 50. doi:http://dx.doi.org/10.7748/ns.29.22.50.e9579

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One legal/ethical issue we haven't previously discussed is research patients.

Does anyone else work with research patients in their jobs? I work with several patients involved in current research studies within the UW's GI department.

The UW does provide guidance for adding the patient’s research consent to their medical record, required documentation of research related care, special instructions for stigmatizing research studies and use of additional Health Link (EPIC) tools. I'm attaching our guidelines, as I believe it's a great way of ensuring that nursing/informatics/health care providers are documenting both legally and ethically.

Reference:
UW Health (2017). Documentation of research related care. Retrieved from https://uconnect.wisc.edu/clinical/tools-resources/ehr/health-link/research/documentation/resources/name-20960-en.file.

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Hi Kathye,
Thanks for your reply! I think the most interesting aspect of this topic is the future use of technology and then its implications on privacy and safety. On one hand, if someone said "I have a tracking device that's implantable, minuscule, and can be placed painlessly in a child. It means that he or she can never be lost or abducted." Parents would rejoice. However, what are the downsides? Of course we want to protect vulnerable populations, and devices that get their start in medical development may be able to do that. But the technology that can be used for good can also be used for evil. It will be interesting (and sometimes scary!!) to watch further development.

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Thank you for your response! I agree, the penalty seems light, as this type of theft is worse than theft of an object. A person's private information that is sold and misused can cause damage that is difficult to trace and repair for many years to come. Purposeful theft of information is different, of course, than an accidental breech, but, as you mentioned, it is extremely important and our responsibility to protect against accidental breech as well. The use of encrypted devices must be emphasized, as there are so many wireless devices used daily in medicine, such as cell phones, tablets and laptops that can be hacked. Thanks again for your post!

-Erin

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Delia MaxwellWhite
Sharon, I believe this video is so true. It took my thoughts right from my mind and played them all out! So cute

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Response # 3 to Mrs. Shepherd and Mr. Czarka

Mrs. Shepherd and Mr. Czarka thank you for the outstanding video titled: “3 Featured Ethical Issues in EHR.”  It was an eye opener to see the extent of violations that can be made by employees to patients whom entrust their medical record information to professional organizations for healthcare services.  In the first case presented in this video, it was interesting to see that an individual employed by a healthcare institution could have stolen patients’ private information for monetary gain for the period of seventeen months and only received six months in a half-way house with a fined of $2,100.  It must have been an insult to the patients whom private information was stolen and sold to a third party that may have used it for identity theft crimes.   In order to prevent this type of crimes, the legal authorities should punish the individual with the full extent of the HIPAA law, which did not happened in this case.   One thing that needs to be said about the institution where the cases scenarios one and two happened, is that this healthcare institution definitely needs to make a complete assessment and improvement in their security measures to protect the patients’ medical record information.  In case two, the contractor’s laptop was password protected but unencrypted, which meant that anyone with computer technology savvy skills could figure out the password and have access to the patients’ private medical record information.  This is why every healthcare organization needs to make sure that all whom have access to patients’ private information using mobile devices, need to have these types of devices evaluated periodically and encrypted by the healthcare organization’s Information Technology Department.  As noted by Ozair, Jamshed, Sharma and Aggarwal (2015), “emphasis must be laid on encrypting mobile devices that are used to transmit confidential information such as Electronic Health Records” (p. 75).

References

Jamshed, N., Ozair, F., Sharma, A., & Aggarwal, P. (2015). Ethical issues in electronic health records: A general overview. Perspectives in Clinical Research, 6(2), 73-76. doi:10.4103/2229-3485.153997

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Response #3 12/8/2017

I found an interesting article related to Google Glass. I had no idea the potential benefits they can have in the clinical/OR setting. Having said that, I found a good article that reviews their use and one of the findings of the study was the potential privacy and security issues they present. I can also see the ability for misuse in the wrong hands. Technology evolves faster than we can write policies. This would not present a problem if everyone shared above par integrity and always practiced ethically. Sadly we are human and can make a poor decision in a split second when we do not utilize our technology wisely.

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Background

Emerging technologies originally developed for the customer sector often find their way into professional environments. A prime example is the use of smartphones and tablet computers in combination with medicine-related apps in hospitals [ 1- 3]. Google Glass [ 4] is another new and promising device originally developed with private consumers in mind that will soon be available for the general public. In principle, Glass is an optical head-mounted display that in addition to its technical capabilities also allows easy communication with various Internet-based services (mainly provided by Google). With some exceptions, its voice and gesture control functionalities allow an almost hands-free mode of operations. Using a prism, the display information is presented on the retina of the user and provides various kinds of information and visual feedback. The device is capable of taking pictures and recording videos by using an integrated camera. By using wireless access to the Internet, this information can be shared with the public. Also, because Glass provides a built-in microphone and a bone conduction transducer for audio signals, voice over Internet protocol (VoIP) communication is easily possible (eg, by using Google Hangout). Various sensors integrated into the device allow using it for rich augmented reality-based applications.

Currently, Glass is in a premarket state and only participants of the Glass Explorer Program have had the chance to evaluate the device so far [ 5], but some reports of proof of concept projects, especially in the medical field, are already available [ 6, 7]. Lucien Engelen, based at Singularity University (Silicon Valley, CA, USA) and in Europe at Radboud University Medical Center, was the first health care professional in Europe to commence research on the usability and impact of Google Glass in the field of health care [ 8]. His collection of reports published since July 2013 comprises descriptions of experiences gained while using the device in a number of settings, including in operating theaters, ambulances, general practices, and other settings. His reports have been published primarily on social media channels [ 9].

At the moment, no empirical evidence for using Glass in a medical setting is known to the authors. A literature search on PubMed using the keywords "Google Glass" only resulted in a limited number of articles [ 10, 11]. Nevertheless, Glass seems to be perfect for hands-free documentation purposes. Therefore, we were interested in the feasibility of integrating the device in a medical setting. We were also interested in usability aspects, including its effectiveness (can users successfully achieve their objectives?), efficiency (how much effort does it take to achieve those objectives?), and satisfaction (was the subjective experience satisfactory?). We decided to use Glass in a medical field where it was possible to evaluate the device with respect to these questions in a real setting while avoiding any risk to patients. The field of forensic medicine was selected as ideal for our purpose because photo documentation is of high value in this field.

Forensic Medicine

There are a number of demands placed on documentation in forensics. The description must be unambiguous and of high diagnostic value, yet easy to comprehend for laypersons, especially in court proceedings [ 12]. Photographic documentation may make a significant contribution to this and is expressly called for in the American Forensic Autopsy Performance Standards [ 13]. Because a textual description of a specific situation, such as anatomical structures, wounds, or hematomas, often requires imagination as well as a good knowledge of anatomy, a photograph may provide valuable help and aid readers in interpretation of the findings, especially if a reference scale is used. During forensic examinations and in autopsies, photographs can be used to document different stages of preparation if the original situation cannot be preserved. Particular findings can be recorded easily, in a timely manner, and are also easily verifiable and cost-efficient because of digital photography. However, when using conventional digital cameras, somebody has to operate the camera and this person must have a minimum of knowledge in camera handling and in the basics of forensic pathology. Until a few years ago, professional photographers were employed for this purpose, but nowadays-at least in Germany-this work has been delegated to the medical examiners themselves for economic reasons. The main problem with this approach is that an examiner who is working on a corpse cannot take hands-free photographs (). Therefore, one has to change gloves to take pictures, often multiple times during the procedure, which costs time and resources. In this context, a camera that could be operated hands-free while taking the pictures and capturing the details the examiner wants with an image quality comparable to a commonly used digital single-lens reflex (DSLR) camera would mark an innovation in this field.

Postmortem Examination and Autopsy

Postmortem examinations can be traced far back throughout history. Although the most important reason to perform such examinations is to determine whether a person is really dead-otherwise resuscitation measures must be initiated-the cause and manner of death (eg, natural death, accident, suicide, murder) has always been of further interest [ 13, 14].

During a forensic examination of deceased persons, the examiner looks for externally visible evidence that may provide a hint to the manner of death, such as injuries, and samples may also be taken. In Germany, there is also a legal requirement to perform a forensic examination on every corpse that is to be cremated. This is because most indications and traces as to the cause of death will be permanently lost after cremation. Still, the results of a forensic examination have their limitations and the cause of death determined in this manner will always just be a suspected diagnosis. A forensic examination will never be able to substitute for an autopsy or have its probative value.

Over 100 years ago, Rudolf Virchow urged doctors to follow a standardized procedure for autopsy cases, which is meant as a useful guidance [ 15]. Nowadays, this is commonly acknowledged, but an autopsy should not be pressed into a rigid scheme [ 13, 16, 17]. Still, it should consist of 2 components, specifically an outer and an inner autopsy [ 18]. After describing the general impression, a systematic description of all body parts is required [ 13, 19]. For this purpose, the head, throat and neck, chest, abdominal wall, back, outer genitalia and anus, as well as the upper and lower extremities are surveyed. Only when this is completed is the inner autopsy started. In Germany, §89 StPO (Code of Criminal Procedure) stipulates that all body cavities (head, chest, and abdominal cavity) must be opened and inspected, even if the cause of death seems to already have been ascertained during earlier steps. Every individual organ has to be examined and dissected [ 13, 19]. If necessary, medical implants or foreign bodies as well as fractures, hematomas, and the skin, may have to be dissected to answer specific additional questions. In other jurisdictions (eg, following the American Forensic Autopsy Performance Standards), autopsies are performed in a similar manner [ 13].

Image Acquisition

We used Glass during one autopsy ( and ). The senior physician leading the autopsy was equipped with Glass and was instructed to perform the procedure following the previously described standards. Beforehand, the physician was trained in using the device and a self-developed app used for capturing images (which we called "Blink-app"), which took approximately 5 minutes in total. Because the device itself is very straightforward to use and the app only requires a single voice command to start and a nodding motion or a head shake (for keeping or deleting an image) once the image is taken, the physician stated he felt confident in using it after he had practiced taking images a few times.

In addition, 16 postmortem examinations of 4 cases were performed by 2 physicians with training in forensic medicine. Both physicians conducted their examinations alternately with Glass (8 examinations) and a DSLR camera (Olympus E-600, lens: Olympus Z uiko Digital ED 14-42 mm F3.5-5.6, 8 examinations) without using the internal flash of the camera. The kind of device and who began the examination on which case was randomized by running a random number generator (with numbers 0 and 1) 3 times: first, to determine who of the 2 examiners should start, the second time to determine the device to use for the first of the 2 examinations of that examiner. The third call was used to determine the order of devices for the second examiner. The forensic pathologists were asked to follow their standardized routine. Therefore, they were not required to take a specific number of pictures, but were allowed to take as many pictures as they deemed necessary for documentation purposes.

Glass

The device-a Google Glass explorer version-available during our prestudy (performed at the beginning of December 2013) ran on Android 4.0.4 (XE11). At the time of the prestudy, the Glass development kit had become available to the general public, which enabled us to build applications using methods and tools already established for other Android-based devices. Specifications of the available developer explorer unit included a Texas Instruments open multimedia applications platform (OMAP) 4430 SoC 1.2G Hz Dual (ARMv7), a 5-megapixel camera, 682 MB of memory, and 16 GB of storage, of which 12 GB were available for user purposes, as well as Wi-Fi 802.11b/g and Bluetooth. Sensors, such as a gyroscope, an accelerometer, and a magnetometer (all for 3 axes), as well as an ambient light and proximity sensors were also integrated in the device [ 20].

Software Setup

For image acquisition, we decided to refrain from using the preinstalled camera app for two reasons. First of all, without having performed an analysis of the data streams that occur whenever the device logs into a wireless network, we were unsure whether data acquired using the stock camera app would be relayed in any way to any third parties, such as Google. This would be understandable from their point of view given that the device available for our study was still at a premarket stage and they would want to obtain data about possible bugs. Nevertheless, although we were dealing with deceased persons, this would still have been problematic because of the sensitive nature, both ethically and legally, of the procedures that were performed. Secondly, at the time of our prestudy, running the preinstalled app completely hands free was problematic. Nevertheless, because of hygiene issues, this is a necessity in most medical environments, including forensic postmortem examinations and autopsies.

Therefore, using the available development kit, a native app was developed that alleviated these problems. This app, called Blink-app, made use of the standard camera application programming interface (API) provided by Google. It could be started through voice commands and used specific but easy to perform gestures, such as nodding or shaking the head (evaluated using rotation vectors acquired from the geomagnetic sensor), to allow the user to specify whether an image should be kept or deleted. Using functionality integrated into this app, all accepted images were stored in a separate folder on the device and were securely transmitted via Wi-Fi to a Linux-based laptop that served as a wireless hotspot for Glass, but did not have any connection to the Internet. On this laptop, an Apache server had been set up to accept and store images transmitted from the device through hypertext transfer protocol (HTTP) POST requests for later evaluation. Additionally, the server setup allowed other personnel to review the acquired images in a Web browser on the laptop's (larger) screen immediately after they were taken. Image viewing could be performed in various scale modes ranging from an overview to zooming into the image (up to its original resolution) to allow onlookers to closely scrutinize specific areas. As soon as the procedures were over, any images remaining on the device were manually deleted.

Usability and Acceptance

The 2 forensic pathologists involved in taking the images were interviewed about usability aspects of Glass in combination with the Blink-app app. We asked questions about general experience, usage, and handling of the device, noteworthy positive and negative aspects, and whether there were any surprises. Because only 2 examiners used Glass, we refrained from using standardized usability instruments.

Subjective Ratings of Image Quality

A total of 6 forensic pathologists (3 male, 3 female; age range 23-48 years, mean age 32.8 years, SD 9.6), with mean work experience of 6.2 years (SD 8.5) were included in this evaluation after having given their informed consent for participation in the evaluation of the quality of the acquired images. The evaluation was done in two parts: the images were divided into 2 groups according to the settings they were taken in (autopsy and postmortem examination) and for each of the images, the device used for acquisition was noted (DSLR camera or Glass) in the internal database of the app we used for presenting and evaluating the images. All pictures were evaluated by all 6 participating forensic pathologists. To avoid differences in presentation, all used the same tablet computer with fixed display settings (maximum brightness and automatic adjustment for brightness had been deactivated) under similar lighting conditions. Also, during their evaluation, the raters were not informed about which of the two devices had been used for taking the presented images.

In step 1, 49 pictures of the autopsy were presented to the participants using a self-developed evaluation app. The images taken by both devices were intermixed and were then presented in a randomized manner on a single 10" Android-based tablet computer (Samsung Galaxy Note 10.1N).

The participants were presented each image sequentially and they had to give their opinion about whether they were satisfied with it with respect to 4 parameters:

1. Region of interest or; specifically, whether all necessary anatomical structures were depicted.

2. Overall color setting; specifically, whether the images allowed adequate discrimination of even small changes in color which could be important to document hints about underlying pathologies (eg, bruises on a decedent's skin). We were not interested in color cast caused by the devices.

3. Image brightness achievable based on the defined lighting installed in the autopsy room. Although one could argue that using a flash might have improved brightness of the images taken with the DSLR camera (and give an advantage to the DSLR camera because Glass does not include a flash), a flash is rarely employed during autopsies or forensic examinations because it could easily cause overexposure at close distances and could also lead to reflections when photographing wet tissue during an autopsy.

Raters were asked to specify their opinion about each image using a Likert scale with 5 levels (ie, ++, +, +/-, -, and --, in which "++" represented a highly positive and "--" represented an extremely negative rating for the respective parameter. For statistical analysis, these values were transformed into numeric values, in which the highest possible rating "++" corresponded to 5 and the lowest rating "--" corresponded to 1.

In step 2, using the images acquired during the postmortem examinations, we were primarily interested in whether there were significant differences in how well users captured the desired anatomy when using either the DSLR camera or Glass. Because one device is handheld and the other is head mounted, the way users aim the device and shoot the image differs. Because there were small but perceivable differences in coloring (specifically, a very slight yellowish tint in the DSLR camera images), we decided to apply an automatic white balancing algorithm integrated into the GNU Image Manipulation Program (GIMP) 2.8 for all images of the postmortem examination. Based on the RGB color model, for each color channel, this algorithm discards pixel values at both ends of the histogram for the respective channel that contributes only to 0.05% of the image and stretches the remaining pixel values as much as possible. This procedure avoids undue influence of outliers at both ends of the spectrum for each of the channels [ 21]. For documentation purposes in forensics, this is a commonly applied method; thus, it does not add any steps. But, in our case, the algorithm was specifically applied because we did not want the raters' decisions about which device was used for each of the presented images to be biased by the differences in tint. With respect to color, as stated previously, we were interested in whether the devices allowed adequate discrimination of colors. Independent of the device used for image acquisition, the algorithm was used on all images acquired during the postmortem examinations without informing the participants about this process before they gave their ratings. After performing the white balance for all 110 pictures of the postmortem examination, the images were loaded into the aforementioned app as described previously and presented to each of the participants in a randomized manner.

Statistical Analysis

An observer recorded the time span (in seconds) required for each single postmortem examination using the stopwatch functionality available on a separate smartphone (Samsung Galaxy S4). The physicians had to start their examinations from a defined location on the bodies to be examined. A Wilcoxon signed rank test [ 22] was used to compare the related samples to detect differences between the devices. For each of the postmortem examinations, the number of images taken with the device chosen for that examination (Glass or DSLR camera) was counted. Before and after each use of Glass during an examination, the remaining battery charge was noted. For all mentioned variables, descriptive statistics were calculated, including the mean and standard deviation (SD).

The descriptive statistics for the ratings included the tabulation of the frequency and percentages of scale items for each item per device. Median values and quartiles were also calculated. To detect differences between the ratings obtained for both devices, we calculated an unpaired rank sum test (2-sided Mann-Whitney U test, with Cronbach alpha=.05 [ 23]). All items were included and there were no missing entries.

To determine interrater reliability (ie, how strongly the ratings of the participants correlated), we calculated intraclass correlation coefficients (ICC) [ 24] for the 6 participants for the items region of interest, sharpness, color, and brightness. The ICC can be used to assess the consistency of quantitative measurements (ie, correlation) between multiple observers measuring the same quantity [ 25]. All observers rated each case-they were not randomly chosen. We considered single values of the observers. We decided to use the ICC (3,1)-type, 2-way mixed with average measures for the calculations that were conducted using SPSS 21 (IBM Corp, Armonk, NY, USA).

Institutional Review Board Approval

The study was conducted with approval by the Institutional Review Board of Hannover Medical School, study number 2069-2013.

Image Acquisition

During the autopsy, 64 pictures were taken: 40 with Glass and 24 using the DSLR camera. A total of 15 images were excluded because they were not related to the deceased person's anatomy, but rather to pictures of additional paperwork provided by the authorities. Thus, 49 autopsy images (Glass: n=32; DSLR camera: n=17) were used for the study. During the postmortem examinations, 112 pictures were taken, 55 of these using Glass and 57 using the DSLR camera. We excluded 2 pictures (for similar reasons); thus, 110 images (Glass: n=54; DSLR camera: n=56) remained for evaluation.

During postmortem examinations, an average number of 7 pictures were taken per case with both devices. When using the DSLR camera, the mean duration of a single postmortem examination was 225.9 seconds (SD 50.6) compared to Glass, for which the mean duration was 268.5 seconds (SD 64.1) (). During the postmortem examinations, an average 5.5% (SD 1.85) of Glass' battery charge was used per case, corresponding to 0.81% per minute or 0.79% per picture.

Interviews

Based on the interviews, we obtained subjective ratings of the user experience for both Glass and the Blink-app app. In the forensic setting, especially during the autopsy, Glass equipped with Blink-app was deemed as a suitable tool for examiners in situations where they needed both of their hands for fulfilling tasks, especially in cases where there is limited opportunity for other persons to take pictures (either because of space requirements or availability). This certainly holds true in autopsy settings. Another useful effect was that other persons attending the procedure (colleagues and a police officer) were directly able to review what the leading pathologist had seen by looking at the laptop's screen (). In the version that was tested, for users who do not have to wear corrective glasses, the device does not disturb the examiner's sight during the procedure and is comfortable to wear because of its low weight and good ergonomics. Even in a busy environment, such as an autopsy with 5 people involved, the voice command used for starting the app worked very well. The integrated gesture control (nodding for upload and shaking one's head for discarding an image) was perceived as natural.

Similarly, for the postmortem examinations, both examiners agreed that the device's ergonomics and light weight made it comfortable to wear. Because the environment is generally quieter when performing this kind of procedure, both the voice and gesture control worked well. The examiners mentioned that taking images using Glass took more physical effort than with the DSLR camera to capture the desired regions of interest (). This was especially the case with close-ups because the device is placed on the head during use and there was no macro function available. Consequently, to obtain images of the region they wanted, they sometimes had to bring their head-and with it the device-closer to the findings than they would have preferred.

Rating of the Images

The 6 raters evaluated 49 autopsy images each, totaling 294 evaluations (DSLR camera: n=102; Glass: n=192), each consisting of ratings on a 5-point Likert scale (from "++" to "--" corresponding to a numeric scale of 5 to 1) for each of the 4 qualities region of interest, sharpness, color, and brightness. shows the absolute frequencies and percentages obtained per quality for each of the scale items for both devices. Differences between both devices are particularly noticeable for region of interest and sharpness. For region of interest, a large percentage of images taken by DSLR camera achieved the highest rating of "++" (region of interest: 57.8%, sharpness: 68.6%), whereas for images taken by Glass, ratings for these 2 qualities were more evenly distributed with a somewhat smaller peak for rating "+" (region of interest: 41.7%, sharpness: 34.9%). The distributions of ratings for color and brightness for both devices were a closer match, although results were also slightly in favor of images taken by DSLR camera.

For the images taken during the postmortem examinations (n=110), a total of 660 single evaluations were obtained from the 6 raters (DSLR camera: n=342; Glass: n=318). Each of the 4 qualities (region of interest, sharpness, color, and brightness) were rated using a 5-point Likert scale (from "++" to "--" corresponding to a numeric scale from 5 to 1). shows the absolute frequencies and percentages obtained per quality for each of the scale items for both devices. Considering the percentage values for the scale items for sharpness, color, and brightness, ratings are only slightly in favor of the DSLR camera. For region of interest, the difference is considerable, as shown when looking at the sum of ratings for "+" and "++" (corresponding to positive and highly positive ratings), which amounted to 90.7% for images acquired using the DSLR camera vs 61% for those taken by Glass.

As mirrored by the median values and interquartile ranges (IQR) shown in , for both devices, the 6 raters were quite consistent in their evaluation of the 4 qualities (region of interest, sharpness, color, and brightness) for images taken during the autopsy (n=49). For the postmortem examinations, raters were again quite consistent in their evaluation of the 4 qualities (region of interest, sharpness, color, and brightness) ().

For image quality, it was of interest whether the region of interest was appropriately captured, whether the image was well focused and sharp, as well as whether color discrimination and brightness were satisfactory for the participants. Instead of using algorithms for an objective interpretation of the images, we decided to obtain subjective ratings by professionals who would have to use such images for their photo documentation if a device such as Glass were to be officially introduced in such settings. Overall, on a 5-point scale (where 5 represented the best and 1 the worst possible rating) the images received good (median 4) and very good values (median 5) in all 4 categories independent of the device used for image acquisition or the setting ().

Pictures taken during the autopsy showed differences between DSLR camera and Glass primarily in region of interest and sharpness (DSLR camera: median 5; Glass: median 4). In color and brightness, the median values for both devices were identical (median 4), but values for the third quartile differed because only the DSLR camera received maximum ratings of 5. Nevertheless, images taken during the autopsy using Glass received significantly lower ratings for all 4 categories than those taken by the DSLR camera (region of interest: z=-5.154, P<.001; sharpness: z=-7.898, P<.001; color: z= -4.407, P<.001, brightness: z=-3.187, P=.001; see ). Raters favored the pictures taken by DSLR camera with respect to correctly capturing the desired region of interest as well as sharpness, color discrimination, and brightness.

Interrater Reliability

The interrater reliability was high (). The ICC for the ratings obtained based on the autopsy pictures indicated a strong positive relationship for sharpness (ICC=.917, 95% CI .875-.948, P<.001) and brightness (ICC=.720, 95% CI .579-.826, P<.001), and a moderately positive relationship between raters for color (ICC=.658, 95% CI .485-.787, P<.001) and region of interest (ICC=.630, 95% CI .443-.770, P<.001). When considering the ratings of the postmortem examinations, the ICC values for region of interest (ICC=.727, 95% CI .639-.799, P<.001) and sharpness (ICC=.761, 95% CI .685-.824, P<.001) indicate a strong positive relationship, whereas color (ICC=.674, 95% CI .569-.760, P<.001) and brightness (ICC=.545, 95% CI .399-.665, P<.001) indicate a moderately positive relationship among the raters.

Principal Findings

In our evaluation, we focused on the main functionality of Glass in areas where we thought it would have an advantage against other existing technology. Because it includes a lightweight head-mounted display and a camera with voice and gesture control in combination with embedded computer and wireless communication technology, it seems ideal for both communication and photo documentation (). We were interested in its effectiveness, efficiency, and user satisfaction.

Overall, both devices had sufficient capabilities and could be used effectively for the task of image acquisition during the procedures. Users were able to successfully achieve their objectives with either device, but we detected differences in the efficiency of the devices. Postmortem examinations performed using Glass for acquiring the photo documentation took 42.6 seconds longer than those performed with the DSLR camera (). The difference was significant. ( z= -2.100, P=.04 using Wilcoxon signed rank test). Overall, this corresponds to one-fifth of the average length of the procedure when using a DSLR camera (3.45 min) and leads to additional undesired expenditure of battery power. On average, 5.5% (SD 1.85) of the battery capacity of Glass was used per case during the postmortem examinations, corresponding to 0.81% per minute or 0.79% per picture.

Although one may suspect that this relatively high power consumption may be because of not using the stock camera app for capturing the images, we do not believe this to be the case. While developing the app, we did not note any differences in power consumption when comparing our app to the preinstalled camera app. As noted previously, the Blink-app app was implemented based on the official camera API calls; thus, both apps made use of the same (or at least very similar) calls to image acquisition functions. Also, when using the Blink-app app, images were saved in the original form available through the official API calls without any alteration. Of course, power consumption is higher with an active Wi-Fi connection, but again, we noted no apparent difference between the stock camera app and the Blink-app app if the device was connected to a wireless hotspot while either app was running. Also, because we were dealing with a premarket device, we expect power consumption and battery capacity to improve in future versions. At the time of our study, our aim was simply to determine whether, in its current state, power consumption was a potential limiting factor or was adequate for our chosen setting without having to resort to external power sources, such as additional battery packs, because these would be problematic in such settings due to external cabling and additional bulk. In medical settings, a cable running down from Glass to an external battery pack may raise concerns with respect to hygiene as well as add potential for Glass to be pulled off the user's nose if something (eg, a fastener on the physician's surgical gown) inadvertently pulled on this cable.

For the DSLR camera, it was not possible to determine the exact percentage of battery power used because the camera only provided an icon with a crude scale in units of 25%; however, no significant loss of battery power could be detected. This is understandable when considering the average battery capacity of current DSLR cameras; thus, no corresponding information is listed in . For Glass, the battery's level of charge quickly decreased; an average 5.5% of the battery's capacity was spent per postmortem examination (0.8% per minute or 1.3% per picture). If all went well and examiners were to use Glass in a similar manner to how it was used in our study, this would allow for approximately 18 postmortem examinations or 125 minutes of use, or 78 pictures. Compared to the DSLR camera, this would require earlier recharging, which could be a problem if there were a large number of postmortem examinations to be performed. But it is expected that a future version of Glass sold to the general public will have an improved battery life. Altogether, the effort necessary for achieving the objectives was higher when using Glass compared to the DSLR camera, and when comparing the percentage of battery charge used, the numbers currently seem to be also in favor of the DSLR camera.

The presentation of the region of interest is the most important aspect that must be covered by the photographer and the device used. For the images taken during the forensic examinations, we decided to apply an automatic white balancing algorithm as described previously to give the images taken by both devices a similar and comparable appearance and to allow the participants to more easily focus on possible differences in the presentation of the region of interest. As expected, the median of the ratings for images taken with Glass or DSLR camera showed lower variability in the median (median 4) in all item categories because of the image manipulation. The IQR showed greater spans in the Glass group (IQR 2) with respect to region of interest, color, and brightness. Based on statistical testing, only the ratings for region of interest ( z=-8.3901, P<.001) and brightness ( z=-540, P=.01) were significantly better for images taken with the DSLR camera, whereas sharpness and color showed no significant differences (). The main disadvantage concerning region of interest is the lack of a zoom function with Glass compared to the DSLR camera.

User satisfaction depends on a number of factors, including the usability of the device and the quality of the images. The interviews about user experience and acceptance of the Glass device underline the comfort of a lightweight voice- and gesture-controlled device with a head-mounted camera. Those questioned perceived the device to be a suitable tool in the situations where they had used it (ie, during autopsy and forensic examinations).

Overall, the experience using Glass was satisfactory although the quality of the images obtained left room for improvement. Our use of the custom app instead of the device's stock camera did not appear to have an influence on image quality. While developing the app, a careful visual comparison of images taken with both apps (taken by the same person with same angle of view and similar lighting conditions because the images were taken at the same location and only a few seconds apart) did not show any obvious differences in color, sharpness, and other parameters. There were also no visual differences with respect to artifacts or depiction of fine structures. Additionally, an analysis of the exchangeable image file format (Exif) data included within the images did not show any notable differences (aside from the timestamp). Therefore, we believe that the quality of images acquired by Glass was not negatively influenced by our app. However, it is to be expected that the manufacturer will refine many of the points we noted (ie, image quality and battery capacity) before the device hits the consumer market.

Limitations

There are a number of limitations in our evaluation. First of all, because of time constraints, we were only able to use the device on a limited number of cases and with only 2 physicians. Also, for our study, the 6 raters included the 2 physicians who took the images, but because of the amount of images taken from similar perspectives with both devices by both physicians and some days having passed between image acquisition and evaluation, we do not believe this influenced the results. When asked, neither of them was able to identify who had taken a specific image because of the random manner in which the images were presented. In most cases, they were not even sure which case an image belonged to. Also, neither of the physicians had any influence on the integration of the selected images in the app we used for image presentation.

Because it was only possible to use Glass during one autopsy, we may have missed differences one might otherwise note with respect to specific types of cases that require other approaches than those commonly used in standard autopsy situations. Establishing a control group could also have improved the results. A larger number of postmortem examinations, ideally performed by additional examiners, would have reduced bias and standardized instruments for measuring usability could have been applied as well (eg, the system usability scale by Brooke [ 26] and Hassenzahl's AttrakDiff2 [ 27]). Raters recruited from other forensic medical facilities would also have improved the data pool used for analysis.

From a technical point of view, it may be seen as problematic to compare the capabilities of a DSLR camera with a resolution of 12.6 megapixels with those of a 5-megapixel camera integrated in a mobile device. Even with recent advances in mobile technology, the quality of a small-lensed camera can never compare to what a DSLR camera has to offer. However, our aim was not a direct comparison of technical parameters but to determine whether the perceived image quality provided by Glass was adequate for the stated purpose; therefore, we do not believe this to be a limitation.

Additional Advice

There are additional aspects that will make the deployment of Glass in clinical settings complicated. These expected complications are not due to purely technical issues, such as image quality or handling, but rather concerns about data protection and privacy. Because Glass was developed primarily for the private sector, its basic functionality and the preinstalled apps make extensive use of Google's network and servers. Therefore, the user has little control over the way data are handled, transmitted, stored, and possibly evaluated by a third party. Because Google is the main company involved, their data protection policy is applied. For the professional medical sector, it is not advisable to send any data of a patient-especially concerning medical issues-using an open and unsecured network. At least in European countries, it is not acceptable to store and share medical data stored in "the cloud" and similar restrictions apply to other countries (eg, the US Health Insurance Portability and Accountability Act does not allow a third party to access patient data [ 10]). Therefore, unencrypted communication or communication over insecure networks for making video calls or doing live chats to exchange information about a patient's case are just as unacceptable as sending pictures and emails containing personal details that help identify the patient.

Currently, when using Glass in a medical setting, a private (closed) network without any connection to servers aside from those belonging to the private infrastructure should be ensured. Additionally, just as for all other applications where medical data are concerned, state-of-the-art encryption and access policies should be employed for access to the infrastructure as well as storage and transmission of all data. For our study, we developed the previously mentioned app that allowed data exchange only within a private network (ie, between Glass and a laptop without Internet access).

There is also an additional point that must be kept in mind regarding apps running on Glass. Just as for other mobile smart devices used in health care settings, there will be additional pitfalls regarding data security and privacy once the market of third-party health apps and medical apps specifically adapted to Glass grows; for example, if manufacturers of apps do not implement appropriate measures for ensuring these aspects in their products. Depending on the jurisdiction they are used in, applications that have a diagnostic or therapeutic purpose (ie, could be rated as a medical device) must already conform to regulations (eg, the Mobile Medical Applications Guidance for Industry and Food and Drug Administration Staff [ 28]), thus ensuring some quality control. Nevertheless, for apps for which such regulations do not apply, it would be highly desirable if manufacturers or developers of an app were to provide users with at least sufficient and transparent information to allow them to make an informed decision about whether they want to use an app-be it on Glass or on other mobile devices-or not. The information should be provided in a clearly structured way (eg, using an app synopsis as presented by Albrecht [ 29]). This could also be used as a starting point for instigating a peer-review process of such applications.

Devices such as Glass can be used unobtrusively without attracting attention of persons who are unaware of the technical possibilities or dangers offered by these devices. As in all areas of medicine, the usual rules regarding a patient's rights of privacy need to be applied, which may easily be overlooked because Glass is so easy to use and integrates well in many settings. Also, because it is currently unknown how living patients will react to the device in an examination and other common settings encountered in the medical field, empirical studies that investigate the acceptance of patients would add significant value if Glass is to be widely deployed. For example, a recent blog entry by Mat Honan [ 30] who used the device for a year indicated issues with acceptance from the public.

Hygiene is also an issue when using the device with patients because Glass is not a medical product and was not developed for use in a sterile environment. Therefore, it is questionable whether it is possible to disinfect it properly. Currently, the manufacturer is not giving any recommendations regarding proper disinfection of the device. By allowing hands-free operation, our Blink-app app supports the demands of hygiene; nevertheless, we used disinfecting wipes for plastic surfaces of medical devices, although this may cause issues with warranty [ 31].

Conclusions

In our opinion, aside from using the device for documentation purposes, there is also potential for another field of application in forensic medicine: By chance, we recognized the reaction of our medical students participating in the autopsy. They were amazed by the pictures taken by Glass that were almost instantly presented on the laptop's screen. Because there is only room for a limited number of students to watch, even for interesting cases, using the described setup with our additional add-ons might provide an opportunity for a larger number of students to observe the procedure in a dynamic manner. There are also a number of other uses in medical education and training one can imagine (eg, cardiology and others described in [ 32]).

The main strength of Glass is its ergonomic and lightweight design, combined with the camera that allows taking pictures and videos directly from the user's point of view. This feature makes the design interesting for medical education (eg, in pathology and in surgery). Independent of the local setting, students and colleagues may join a complicated autopsy or operation and can see exactly what their teachers see, thus learning from watching their actions from the ideal perspective (). This is similar to the potential benefit also already noted-albeit for education in general-by other authors [ 32- 34]. If worn by students, Glass could also serve to enhance existing augmented reality-based solutions for medical education, such as mARble [ 35], an augmented reality-based blended learning tool for use in medical education that is currently implemented for conventional smartphones and allows students to immerse themselves in an almost realistic learning scenario in cases where learning on real patients may be restricted (eg, because of ethical concerns). It remains to be seen whether the current comparatively low display resolution of Glass is sufficient to provide students with content similar to what can currently be shown using the smartphone-based solution (eg, by overlaying specific medical findings on another student's skin). If yes, Glass would also have potential to significantly enhance augmented reality-based learning tools.

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Google Glass for Documentation of Medical Findings: Evaluation in Forensic Medicine

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Google Glass is a promising premarket device that includes an optical head-mounted display. Several proof of concept reports exist, but there is little scientific evidence regarding its use in a medical setting.The objective of this study was to empirically ...

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Chris this is hilarious and so true!! There are so many advantages to technology and I honestly don't think I could make it through some workouts without good music helping me along. But there are downsides as well! My mom used to own a gym that had feedback on the equipment. Those working out would wear a wristband tracker would light up red/yellow/green to alert the user to obtain optimal performance on a machine. At the end, a summary would be available on a computer screen for users to see their estimated calorie burn, muscle group engagement, etc. When there was a malfunction, users would get so frustrated, claiming the workout was useless!! My mom constantly lamented having to remind adults that the sweat and benefits of the exercise were quite real and the only thing that mattered- not the technological feedback!

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Chris,                          You are very correct. The upcoming technological advances that become available to the public, is an amazing step in progress towards self-independence, compliance, and patients understanding of the available methods that are availed for treatment and improving clinical outcomes and patient health prevention. “Aged care is flooded with discussions of technology to improve responsiveness, costs and quality of life. Of the many terms being thrown around, including telehealth and telecare, the overarching term is smart assistive technology (SAT). “Many SATs exist in the market. To name a few: bed sensor mats, GPS watches, fall detectors, social robots, robotic vacuums, and a blood pressure monitor linked to a centralized monitoring center”, (Mackrani, 2015).                  ReferencesMackrani, S. (2015). Technology development in dementia. Australasian Biotechnology, 25(1), 19                          Manny

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Chris,                          You are very correct. The upcoming technological advances that become available to the public, is an amazing step in progress towards self-independence, compliance, and patients understanding of the available methods that are availed for treatment and improving clinical outcomes and patient health prevention. “Aged care is flooded with discussions of technology to improve responsiveness, costs and quality of life. Of the many terms being thrown around, including telehealth and telecare, the overarching term is smart assistive technology (SAT). “Many SATs exist in the market. To name a few: bed sensor mats, GPS watches, fall detectors, social robots, robotic vacuums, and a blood pressure monitor linked to a centralized monitoring center”, (Mackrani, 2015).                  ReferencesMackrani, S. (2015). Technology development in dementia. Australasian Biotechnology, 25(1), 19                          Manny

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Emily,                     Thank you for the remarks. You are correct about secure messaging and the interrelationship with e-messaging and information technology interactions with health care.    Health care and nursing studies and efforts should address e-messaging literacy, interoperability of various internet systems, access to health information availability, and secure messaging systems. Nursing must and should acquire deeper understanding of the interactions between health care work systems and the role of organization and external environment factors. “…communication technologies are being integrated into health care systems providing a platform for patient-provider communication; in an attempt to increase access and promote self-care management. Patient-provider communication is a central component to improving quality of care and patient outcomes”, (Haun, Lind, Shimada, & Simon, 2013).ReferencesHaun, J. N., Lind, J. D., Shimada, S. L., & Simon, S. R. (2013). evaluating secure messaging from the veteran perspective: Informing the adoption and sustained use of a patient‐driven communication platform. Annals of Anthropological Practice, 37(2), 57-74. doi:10.1111/napa.12029                            Manny

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Emily,                     Thank you for the remarks. You are correct about secure messaging and the interrelationship with e-messaging and information technology interactions with health care.    Health care and nursing studies and efforts should address e-messaging literacy, interoperability of various internet systems, access to health information availability, and secure messaging systems. Nursing must and should acquire deeper understanding of the interactions between health care work systems and the role of organization and external environment factors. “…communication technologies are being integrated into health care systems providing a platform for patient-provider communication; in an attempt to increase access and promote self-care management. Patient-provider communication is a central component to improving quality of care and patient outcomes”, (Haun, Lind, Shimada, & Simon, 2013).ReferencesHaun, J. N., Lind, J. D., Shimada, S. L., & Simon, S. R. (2013). evaluating secure messaging from the veteran perspective: Informing the adoption and sustained use of a patient‐driven communication platform. Annals of Anthropological Practice, 37(2), 57-74. doi:10.1111/napa.12029                            Manny

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Great link. I continue to be saddened by the viciousness of cyberbullying in our society. It is too easy and without proper parental supervision children can take it much too far. Of course, sometimes the parents are involved. I loved the article. I have learned the difference in my children's personalities when they have used too much technology for the week and it is notably worse. It is my encouragement to make them put it down and enjoy life without it!
Thanks,
Kathye

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I did not realize that health records were not 100% encrypted when they are transferred to a back-up device. According to this video - the two biggest reasons for data breach are human error and unauthorized access to back up devices that have not been encrypted. I can understand how this could make our patients a little nervous. Also, the ability of the government to access "big data" for their own use is a little scary.

I am stuck in my own little ethical dilemma between allowing government and law enforcement easy access to health records to evaluate a person's mental wellness and the patient's right to personal privacy. Which to choose.... Safety for the greater good or the individual rights of the patient. While we enjoy many rights as American citizens provided under the Constitution - where do we draw the line when we have the technology available to possibly prevent harm to another.
As more and more data is available this will be an interesting topic to follow.
Thanks,
Kathye

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electronic medical record (software genre)

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storagepipe - Online Backup and Disaster Recovery

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Privacy and Protection Of Electronic Medical Records (EMR)

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3. What new medical technology have you heard of that would be exciting to implement in your field of practice? Are there any associated ethical issues?
As we progress into the future, technology is going to be high on the list of things that help us to progress. In that aspect I believe in future tech and hope that applications will be adopted. One thing that I find fascinating is the 3D organ printing, something that is currently being explored an applied in different avenues of medical advancement. The potential applications are endless and that in its self leads it to being open for exploitation. Currently there are researchers that are working on organs, hips, blood vessels and many more. https://wyss.harvard.edu/keywords/3D+Organ+Engineering/
As they are still in development, the hope is always that progression will be for the right reasons and not just financially linked. As longterm effects and full implementation are unknown, issues could still arise that haven't fully been explored.

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Sharon,We may not stay at the top of the list, but we will always be the patient’s best friend, and lifelong advocate. We are the primary care takers and the individuals that encounter the patients at the worse time in their lives, illness, tragedy, and death at times. During all these phases we are there for them, to hold their hands and offer a calming word or a smile. We offer advice and may impact each person life.Manny

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Sharon,We may not stay at the top of the list, but we will always be the patient’s best friend, and lifelong advocate. We are the primary care takers and the individuals that encounter the patients at the worse time in their lives, illness, tragedy, and death at times. During all these phases we are there for them, to hold their hands and offer a calming word or a smile. We offer advice and may impact each person life.Manny

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Natalie,We care for patients because they are ill, because they need our assistance returning to their previous level of care. Nurses are the most trusted professionals who individual divulge all personal and intimate communications, behaviors and emotional conduct. Application-Integra table devices have become an integral monitors and measuring tools for most of our patients on a daily basis which is utilized for the physical ailments, medical conditioning and health care maintenance. Electronic remote devices which transmit daily and monthly reports and reading about heart monitoring devices which measure a-fibs, PVC’s and heart electrical regulatory mechanism. Medical management electronic devices do indeed transmit information, stor information, however should consents be requested or written for all ? isn’t it part of the device manifestation of its action?Manny

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Natalie,We care for patients because they are ill, because they need our assistance returning to their previous level of care. Nurses are the most trusted professionals who individual divulge all personal and intimate communications, behaviors and emotional conduct. Application-Integra table devices have become an integral monitors and measuring tools for most of our patients on a daily basis which is utilized for the physical ailments, medical conditioning and health care maintenance. Electronic remote devices which transmit daily and monthly reports and reading about heart monitoring devices which measure a-fibs, PVC’s and heart electrical regulatory mechanism. Medical management electronic devices do indeed transmit information, stor information, however should consents be requested or written for all ? isn’t it part of the device manifestation of its action?Manny

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Kaitlyn,You are correct about the primary care issues and outpatients. Outpatients are becoming a great part of our health care environment.  As it is evident from the growing numbers of the various outpatient programs, treatment and all healthcare modalities. Outpatient will become the way of the future, also in respect to upcoming reimbursement issues. As for the issue of wearable and qualitative data, and qualitative health care that empowers health issues of total quality of life. This qualitative will propagate quality outcome of such interventions. These wearable and quality of care, offers independence and continues healthcare services,” They allow consumers to continuously monitor physiological parameters and manage their health and well-being on a personal basis, or grant physicians access to their health data and receive personalized medical care”, (Marakhimov, & Joo, 2017).ReferencesMarakhimov, A., & Joo, J. (2017). Consumer adaptation and infusion of wearable devices for healthcare. Computers in Human Behavior, 76, 135. doi:10.1016/j.chb.2017.07.016

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Kaitlyn,You are correct about the primary care issues and outpatients. Outpatients are becoming a great part of our health care environment.  As it is evident from the growing numbers of the various outpatient programs, treatment and all healthcare modalities. Outpatient will become the way of the future, also in respect to upcoming reimbursement issues. As for the issue of wearable and qualitative data, and qualitative health care that empowers health issues of total quality of life. This qualitative will propagate quality outcome of such interventions. These wearable and quality of care, offers independence and continues healthcare services,” They allow consumers to continuously monitor physiological parameters and manage their health and well-being on a personal basis, or grant physicians access to their health data and receive personalized medical care”, (Marakhimov, & Joo, 2017).ReferencesMarakhimov, A., & Joo, J. (2017). Consumer adaptation and infusion of wearable devices for healthcare. Computers in Human Behavior, 76, 135. doi:10.1016/j.chb.2017.07.016

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Manny

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Response # 2 to Mrs. Shepherd and Mr. Czarka

Mrs. Shepherd and Mr. Czarka thank you for your video “Regulatory Requirements for Healthcare Informatics.”  This video was easy to follow and educational.  The video addresses the important role of Nursing Informatics.  In this professional role, the nurse creates workflow for the healthcare team using the new technology such as the electronic medical records to improve documentation, information and communication.  Nursing informatics also provides decision support for the healthcare staff.  It focuses on discovering ways to advance information management and communication in nursing to improve efficiency, decrease cost as well as improve patient care.  One of the crucial responsibilities of Nursing Informatics is to make sure that the implementation of new healthcare technology does not infringe on the patients’ rights to confidentiality.  This healthcare professional has to be knowledgeable of the laws that protect patients’ rights to confidentiality.  According to Sewell (2016), “healthcare personnel and those involved with informatics with access to confidential information have a special obligation to abide by the professional ethical standards and legal statutes in the handling of information” (p. 387).

The United States government has implemented legislations that forces healthcare organizations to protect patients’ rights to privacy and confidentiality especially when utilizing the electronic medical records.  There are four laws mentioned in this video which were created to protect the patients’ confidentiality, these laws are: Health Insurance Portability and Accountability Act (HIPPA), Affordable Care Act (ACA), Health Information Technology for Economic & Clinical Health Act (HITECH) and U.S Food and Drug Administration Safety and Innovation Act (FDA).  One law that is important to keep in mind is HITECH.  This law governs the interoperability of healthcare data.  The expansion of healthcare organizations into healthcare systems increases the interoperability of patients’ electronic medical records vulnerability to potential privacy violations.  This legislation also forces healthcare organizations/systems to safeguard the patients’ electronic medical record information diligently, if not large penalties for security breaches in confidentiality will be charged to the healthcare organizations/systems.

References

Sewell, J. (2016). Legal and ethical issues. In Informatics and Nursing: Opportunities and Challenges (5th ed., pp. 387-399). Philadelphia, PA: Wolters Kluwer

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Over the past 10 years, the video game industry has increased by almost 300%. This money goes to funding and creation of more video games to be played by kids. " Currently there are more than half a...

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2. Explore one Pro or positive use and one Con or negative use of a new technological advancement- wearable trackers/monitors, biosensing garments, Google Glass, etc.
Well I think that it is certainly clear when you walk around the airport, train station, mall etc. that technology has taken over our lives in many ways. It has absolutely improved outcomes for many individuals who would otherwise not pay particular time or attention to their own health. This has to be one of the biggest progressions in medical advancement, immediate feedback for the wearer, providing instant gratification, trackable performance and direct communication with providers. However, at what cost to society does technology go too far. I think that we have to embrace  technology but be equally aware of what makes us human. This picture depicts some of societal issue, people not communicating by voice but texting when sat next to each other. https://www.cnbc.com/2015/08/15/gy-killing-the-human-touch.html
The potential for cyber bullying is exponential with the younger generation and teaching them the benefits of communication is paramount for social existence. I am a techno-person, I love my gadgets, but I know the benefits of unplugging and I still embrace technology on a daily basis.
http://www.nasdaq.com/rewritetomorrow/index.html#/?sfid=digitalad1M&channel=Advertising&source=CNBC&offer=Website&utm_content=Male_Market_Tech_300x600&utm_source=CNBC&utm_campaign=digitalad1&utm_medium=cpc

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Question #3
There are so many upcoming potential technologies that can impact healthcare positively. Some of them are exciting and some are almost scary. Working in a hospital, one of the things that is toughest to accomplish is accurate blood glucose monitoring on Diabetics. This new technology can help diabetics monitors their interstitial glucose levels. This is a more accurate value and additionally provides for better control but showing trends. This would allow the user to see what happened to their glucose levels before, during and after exercise, meals, etc.... In addition, you do not have to poke the fingers every time a glucose reading is needed. In this case, the information connects to their smart phone. In a hospital setting, one ethical concern would be if someone were to be able to hack the data and mess with values that are downloaded. Could cause patient harm.

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There's a new way for people with diabetes to monitor their blood sugar levels that doesn't rely on finger prick blood tests. What it does use is a sensor on the arm and the kind of technology used in contactless bank cards.

The new-style monitor licensed for use in the European Union is the FreeStyle Libre by Abbott.

It has just been approved for NHS funding by the NHS Business Services Authority.

Is the new sensor system the same as a continuous glucose monitoring system (CGM)?

It's not. The company which makes the sensor says: "The FreeStyle Libre System is not a CGM device." Abbot says it has developed 'a new category' of glucose monitoring.

The sensor is designed to be worn for 14 days and is intended to replace blood glucose meters whilst still giving people with diabetes continuous glucose monitoring-like information.

How does it work?

First you have to fix the sensor to the back of your upper arm in a procedure which is said to be no more painful than a typical finger prick test. The sensor is pressed onto a disposable applicator and then the applicator is pushed down firmly to apply the tiny sterile sensor to your upper arm. The sensor goes just under your skin and is connected to a white, water-resistant plastic patch similar in size to a £2 coin.

The sensor monitors glucose in your interstitial fluid - the fluid between your cells - rather than blood glucose levels. The sensor is also fitted with a transmitter that wirelessly transmits results to a special scanner, or an app on your smart phone, to see what your glucose levels are. You hold the scanner, or your phone, close to the sensor for about 3 seconds. You can scan your arm through your clothes.

With a finger prick blood test you get a snapshot of where your blood glucose levels are. With the new sensor every scan shows your current glucose reading, a trend arrow indicating the direction your glucose is heading and the last 8 hours of your glucose history. This lets you know how food, activity and insulin affect your glucose levels - day and night.

Advantages

The benefits of the FreeStyle Libre monitoring system are:

It's discrete and convenient

It takes readings every minute - but you won't be aware of this

It gives 8 hours of easy to view glucose history which means patients get more information about the effects of different foods and activity on their glucose levels

It's factory-calibrated so it doesn't require finger prick blood glucose measurements for calibration

The sensor remains inserted for 14 days

It stores your readings for up to 90 days

It provides an easy way to share information with your doctor or diabetes nurse

It's approved for children aged 4 to 17 and means parents or carers can manage night-time monitoring with a scan, rather than having to wake children to take a finger prick blood test

It can be used whether you use an insulin pump, multiple daily insulin injections, other diabetes medications or diet and exercise

It's reported to be about as accurate as a CGM.

Disadvantages

It's not the end of all finger prick tests and there will still be times when they are necessary. For example, when blood glucose levels are rapidly changing, since interstitial fluid glucose levels may not accurately reflect the current blood level, or when the system reports hypoglycaemia or impending hypoglycaemia, or when the patient's symptoms don't match the device's readings.

The FreeStyle Libre does not have any alarms alerting you to the fact your glucose levels are too high or too low, nor does it include a 'share' feature to allow for remote monitoring by another person.

Not everyone gets on well wearing the sensor, some find it itches and some have insertion-site reactions.

Has it been trialled?

A 6-month study, published in The Lancet in September 2016, found it significantly reduced hypoglycaemia without raising HbA1c levels in insulin-treated patients with type 1 diabetes, compared with self-monitoring of blood glucose using finger pricks. The research monitored 328 patients with type 1 diabetes from 23 European centres - Sweden, Austria, Germany, Spain and the Netherlands.

The lead researcher, Professor Jan Bolinder, professor of clinical diabetes research at the Karolinska Institute, Stockholm, Sweden, told Medscape: "When the patients started using the Libre device, they instantly tripled their rate of self-monitoring, and this resulted in a marked reduction in time and events spent in hypoglycaemia, time spent in hyperglycaemia, an increase in time spent in optimum range, less glucose variability, and improvements in quality-of-life measurements."

At the European Association for the Study of Diabetes 2016 Annual Meeting, Dr Thomas Haak, of Diabetes Zentrum Mergentheim, Germany, presented data showing similar outcomes with the FreeStyle Libre system in patients with type 2 diabetes on intensive insulin therapy.

A study published online January 31 in the Archives of Disease in Childhood found the FreeStyle Libre system was accurate, safe and suitable for a broad range of children and young people with diabetes. The study involved 89 children aged 4 to 17 years with type 1 diabetes in 9 UK diabetes centres. Participants were asked to perform four capillary blood glucose tests daily, each immediately followed by a sensor reading.

The company behind the FreeStyle Libre funded the trials.

"Life-Changing"

Reacting to the NHS funding announcement in a statement, Diabetes UK chief executive Chris Askew, says: "Today's announcement is fantastic news: Not since the transition from urine testing to finger-prick testing has there been such potential to transform the lives of people living with type 1 and type 2 diabetes through technology.

"Flash glucose monitoring can free people living with diabetes from the pain and rigour of frequent finger-prick testing, and puts them in greater control of their condition. In doing so, it has the potential to help prevent a host of devastating long-term complications. Today's decision is testament to the commitment of campaigners, clinicians and policy makers to making this technology available.

"The challenge now will be that everyone who could benefit from this technology is able to access it where they live. Diabetes UK will be looking to local decision makers to ensure people living with diabetes get proper access to this potentially life-changing technology."

Abbott news release

Diabetes UK

FreeStyle Libre website

The Lancet: Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial

Flash Glucose-Sensing Technology as a Replacement for Blood Glucose Monitoring for the Management of Insulin-Treated Type 2 Diabetes: a Multicenter, Open-Label Randomized Controlled Trial

BMJ Journals: An alternative sensor-based method for glucose monitoring in children and young people with diabetes

Diatribe - making sense of diabetes

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There's a new way for people with diabetes to monitor their blood sugar levels that doesn't rely on finger prick blood tests. What it does use is a sensor on the arm and the kind of technology used in contactless bank cards.

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Response #2
2. Pros/Cons of new tech. First I'm attaching a cartoon that I felt was truly hilarious and shows one of the CONS of new tech. People get so caught up in the new gear that it takes some of the element of fun out of it. Instead of exercising for the camaraderie and friendship, people focus on the tech and social media. PROS of new tech are that it gets people moving that might not have in the past. In addition, instead of running and listening to your body, people run by a watch and the pace. Therefore overdoing it sometimes and pushing into injury. The tech takes a lot of the personal side of things out of it.

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Hello Legal and Ethical Issues in Healthcare Technology Advancement Team:

I was able to read your paper today and wanted to commend you on a job well done. I especially enjoyed the section that discussed the Hospital of the University of Pennsylvania’s study on the use of text messaging and you asked some great questions at the end of that paragraph, which lead me to do some of my own research on the topic.

I found a research study completed by Haun, Patel, Lind & Antinori (2015), which showed that participants were “satisfied with secure messaging” because they found it to be a quick, safe and easy-to-use communication tool (p.5). According to the authors, patients utilized the messaging tool for the following reasons: medication refills, obtaining lab results, appointment management, asking health-related questions and for discussion of sensitive health topics, respectively (Haun et al., 2015, p. 1). The authors note that a patient’s gender, level of education, income, health and E-literacy levels also play a role in a patient’s level of satisfaction with and perceived ease of use with messaging, as well as whether or not they will choose to use such a tool (Haun et al, 2015, p. 11). I’ve attached the article for anyone interested in reading more details of this study.

Reference:

Haun, J., Patel, N., Lind, J., & Antinori, N. (2015). Large-scale survey findings inform patients' experiences in using secure messaging to engage in patient-provider communication and self-care management: A quantitative assessment. Journal of Medical Internet Research., 17(12), 1-12. doi:10.2196/jmir.5152

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Week #7 12/6/2017

1. I do believe that nurses will continue to stay on the top of the most trusted professionals list. According to our reading this week, firefighters took the lead after 9/11 and understandably so. However, nurses remain in a pivotal position to ensure the care of people across the globe and touch the lives of patients and families alike. We are the ones at the bedside for the good, bad, and ugly and have the ability to show true care and compassion in the lives of those we care for. As long as we continue to raise up our young nurses well to maintain their personal and professional integrity, understand their legal, personal, and professional responsibilities -  we will continue to earn the respect of many.

2. I LOVE my Apple Watch. It knows when I need to stand, it knows when I need to take a deep breath and at the end of the day it has tracked all of my steps and exercise/heart rate. I think there is true value in this technology to encourage me to keep moving all day long. The con is if this data is able to be linked to me personally and then left unsecured in cyber space where anyone could access it our use it inappropriately. I.e: if an insurance company got ahold of the data and based my premium on my lack of exercise or patterns of heart -rate, etc... Far fetched - maybe. But just a thought.

3. The nanotechnology has true positive attributes! However, again I understand the whole ethical and privacy debate.  As an ED nurse I have said a million times I wish I had a way to obtain accurate health history and information on an unconscious/unknown patient with no one to speak for them. This would present a beneficial use for this technology, the patient, and the healthcare team working with them.

Great presentation this week! A ton of information!
Thanks,
Kathye

Sewell, J. P. (2016). Informatics and nursing: opportunities and challenges. Philadelphia: Wolters Kluwer.

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According the Gallup Poll, 84 percent of Americans rated nurses’ honest and ethical standards as “very high” or “high” (American Nurses Association, 2016).  I firmly believe nurses will continue to take the #1 place in the Gallup Poll as the most trusted profession for multiple reasons.  Nurses are always on the front line of healthcare providing care to individuals in some of their most vulnerable moments.  While some nurses lack integrity and compassion within their practice, for the most part, nurses prove themselves worthy of trust from their patients.  As nurses, our primary goal is patient safety, and we strive to advocate for the best interest of our patient’s safety at all times.  Not only do patients depend on us but the doctors look to us for our experience and expertise to help guide their decision-making.

Nurses are the eyes, ears, and hands of the doctors and we are always at the patient’s bedside providing care and building trust and rapport with the patients.  When the patient needs something, they call their nurse.  When the patient has a question, they ask their nurse.  When the patients need a medical professional to talk to they come to their nurse.  The patients have an inherent trust in our skills and integrity.  In my opinion, there is not another profession that can carry so much weight when it comes to trust, integrity, and ethics.  Our work directly affects the well-being of individuals regardless of their age, race, ethnicity, and background.  Patients are more empowered to have better outcomes if they have someone on their side advocating for them.  Without this trust, patients are more reluctant to make poor health choices and have poor outcomes.  Without trust, our efforts can be in vain.

Reference:

American Nurses Association. (2016, December 19). Nurses Rank #1 Most Trusted Profession for 15th Year in a Row. Retrieved from American Nurses Association: http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2016-News-Releases/Nurses-Rank-1-Most-Trusted-Profession-2.pdf

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Here is a great article about informed consent and big data.  As huge amounts of data are collected it begs to question if patients have truly given their consent for the various research studies for which their information is used.  Bioethics is becoming a big conversation piece as research studies harness information from these databases.  We need to leverage the technology and data available with the ethical reasons for collecting the data.  Natalie Peleg

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If patients are told about medical studies they're in, what, exactly, will they be told?

A research network funded with millions by the Affordable Care Act will begin conducting vast studies next year to compare standard medical treatments. But what about the 100 million patients in the network - do they have a choice in the matter?

Will researchers get permission from each of those patients? And if patients are told about the studies, what, exactly, will they be told? These questions have bioethicists, scientists and health care officials debating how to bring the question of patient informed consent into the 21st century.

Story Continued Below

Obamacare is best known for extending health coverage to more Americans. But the health care law has many provisions aimed at improving health care outcomes and safety while lowering costs. One element is "comparative effectiveness" research: not just finding out whether a drug or treatment is safe and effective but comparing drugs head to head to find out which is better, for everyone or certain populations.

And with electronic medical records and vast pools of data, some of these studies have the potential to make lightning-fast, dramatic discoveries. But informed consent issues have the potential to slow such studies and make them too expensive.

( Also on POLITICO: Hackers steal 4.5M patients' data)

Moves are afoot to overhaul federal regulations such as the 1991 Common Rule, which governs informed consent in all federally backed research, according to Kathy Hudson, the National Institutes of Health deputy director for science, outreach and policy. But such rule-makings are long drawn-out affairs that won't happen in time to get the comparative effectiveness research underway.

The principle of informed consent - the idea that patients need to be advised of a study and its risks - was enshrined at the Nuremberg trial of Nazi doctors in 1947. But the process has grown cumbersome and expensive. Informed consent forms can be 30 pages long and may seem aimed more at protecting hospitals from lawsuits than informing patients.

No one wants to expose patients to dangerous trials without their consent. In these comparative effectiveness studies, the risks are usually small or similar for different groups of patients. And researchers are intent on gaining some degree of patient engagement in the studies.

Drug companies and other deep-pocketed sources are rarely interested in funding such studies, though, so there's a pressing need to make them cheap. Traditional drug trials can cost hundreds of millions of dollars each.

( Also on POLITICO: Will better technology save the VA?)

Many comparative studies are planned by the National Patient-Centered Clinical Research Network, which involves 11 research networks and 19 patient advocacy groups. It's getting at least $100 million from PCORI, the Patient-Centered Outcomes Research Institute, which was created and funded - to the tune of about $650 million per year - under the health law.

For comparative effectiveness trials, patients might be randomly selected to receive one of two drugs. In other studies, researchers might simply electronically rummage through patient files to examine outcomes from similar drugs in similar populations. Both types of study raise practical questions for informed consent.

Some patients in the records-based studies might be dead, or impossible to reach. As for the randomization trials, "How do you integrate consent for research into regular health care delivery if you have 1 million patients and 20-30 minutes for each clinical encounter?" asks Joseph Ali, a researcher at the Johns Hopkins Berman Institute of Bioethics.

Most everyone agrees that "informed consent needs to be fixed," says Julia Adler-Milstein, a health informatics specialist at the University of Michigan. "If we can't do informed consent right, we'll be so much more limited in what we can do with data, and that would be a huge loss."

The power of big data

Doctors often prescribe drugs without knowing whether they are the best choice. For example, a common anti-hypertension drug is the diuretic hydrochlorothiazide. The older, cheaper drug chlorothiazide may be just as good, but doctors almost always prescribe hydrochlorothiazide - possibly because its abbreviation is widely known and easy to scribble on a pad: HCZT.

Both are safe and effective; the FDA has established that. But there no requirements and few incentives in the current system to figure out which drug is better.

A physician studying a relatively rare disease, meanwhile, could easily recruit thousands of, say, cystic fibrosis patients from a database that included millions of people. "I will no longer have to spend years recruiting 3,000 patients for a study, because I will already have 10,000 banging on the door," says Michael Lauer, director of the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute.

"As a Harry Potter fan, this is magic in the muggle world," Lauer says. "It will allow us to do dozens, hundreds of large-scale studies at a very low cost."

Would it be necessary to tell patients they were in such a trial?

This article tagged under:

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A research network funded with millions by the Affordable Care Act will begin conducting vast studies next year to compare standard medical treatments. But what about the 100 million patients in the network - do they have a choice in the matter? Will researchers get permission from each of those patients?

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Thank you for your post. It was interesting to learn about the technology related to spinal fusion- I have never heard of that before. Also, the heart monitor you described sounds much more user-friendly than the traditional Holter monitor, and I think we will continue to see both new technology and revision of old technology to create more discreet, user-friendly and efficient monitors.

-Erin

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I, too, hope to see this technology develop further for Labor and Delivery. There are some decisions that need to be made when monitoring is difficult, and I'm sure you have seen internal monitors placed related to difficulty of EFM related to BMI. If more accurate monitoring can be developed, it would one instance in which ideally there wouldn't be any ethical objections, since most women consent to fetal monitoring upon hospital admission. Thanks for your post!

-Erin

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Hi Sharon,
I think you're right! It isn't a sure thing that nurses will remain at the top of the poll! We need to continue to do our best to uphold our patient's trust and respect as well. We are in a unique role to obtain personal and critical information from our patients that may impact their health or medical care.

-Erin

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I enjoyed reading your paper on Legal and Ethical Issues. Actually, I got a better understanding on the importance of documentation and documenting correctly. The information about the patient

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Google Glass Wear: These are really cool glasses but it may be worst than texting.

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Hi Kaitlyn,
I agree with your statement that nurses genuinely want to protect our patients, their information, and their privacy. I think this incentive comes from what we learned in school, what the law and ethics code tells us, but also from an innate desire to safeguard our patients. Laws don't prevent wrongdoing. Nurses recognize their unique role during the most vulnerable time in patients' lives, and I believe there is a respect of this vulnerability and the inherent power of our role.

-Erin

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Hi Natalie, thanks for your reply! I agree with your discussion on the pros/cons of data gathering and storage. On one hand, wearable devices are essentially of very little value if they do not store and transmit data. On the other hand, where that data goes, on what network it is transferred upon, and how and location and duration of storage can pose questions and problems. I agree- is consent implicit upon wearing the device? Will informed consents become a part of engaging wearable technology in medicine, like they are for a procedure?

-Erin

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1.       Do you believe nurses will continue to take the “number on” place in the Gallup Poll as the most trusted profession? Yes, because nurses play an intricate part in the healthcare system. No matter where a nurse may go, if an emergency happened people will naturally feel safer. All because of the knowledge taught in the medical field.

2.        I explored Google glass and found it to be interesting. Google glass has become popular amongst consumers. Google glass is a device that displays information into a smartphone -like hands free format that interact with the internet. Google glass has the potential to bring new possibilities to educators and students. An advantage of google glass is it could guide a surgeon using visuals of the technique or allow a surgeon to view radiology images during surgery (Sewell, 2016). Disadvantage-google glass could lead to eye strain and visual confusion due to the positioning of the micro displayed outside of the person’s natural field of view (Spargaliyev, 2014).

3.       What new medical technology have you heard of that would be exciting to implement in your field of practice? Are there any associated ethical issues? The breath glucose detector which is designed to measure exhaled acetone for diabetes management. I don’t see this associated with any ethical issues compared to implantable chips.

Reference

Sewell, J. (2016). Informatics and Nursing: Opportunities and Challenges (5th e.d). Philadelphia, P.A: Wolters &Kluwer

Spargaliyev, D. (2014). Wearable Learning:  How Google Glass is Changing Education. Retrieved from ceur-ws.org/vol 1154/paper18.pdf
Delia MaxwellWhite

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Thank you, Carolina, for your insightful response. You are correct in pointing out how remotely we can access information, and it is all on the honor system with where and how we do so. Despite the Code of Ethics and the legal and social ramifications, it is our own personal ethical standards that protect patient information.

-Erin

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Thanks for discussing your personal experience with trackers and staff/patient responses. It doesn't surprise me that there were some objections to wearing the devices. I think, as with anything, there will be people who refuse to participate. With some devices or procedures it can be more understandable than others, but truly it is a good example of exercising the ethical/moral rights of the individual and the right to refuse. Thanks for your post!

-Erin

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Thanks for your response, Chris! I agree, despite some bad interactions that are inevitable, I feel that patients and their families often see how involved nurses are in patient care.  I think the poll results represent all of the lives nursing touches, and it is an honorable distinction.

-Erin

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Hi Janice, thank you for your response. I think you are correct- despite the risk of device malfunction and the fact that they only work if they are worn by patients, wearable devices can have a much better chance of accuracy than patient reporting. Some patients are simply poor historians, others don't know what is medically relevant or forget to tract medically relevant data.

- Erin

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Thanks for your reply, Emily! That new technology sound so exciting! Thank you for introducing me to an advancement I had never heard of before. According to Lee (2016), there is recent development of a "breathprint" for 17 different diseases. It is described as "smelling" using chemical sensors and identifying using algorithms. Benefits include ease of sampling, lack of invasiveness or pain, and also simplicity of re-testing. This testing shows promise for informing providers on the status multiple organ systems as well. What an exciting development to follow! Thank you for discussing so well how it would affect your area of practice.

Lee, L. (2016) Scientists identify unique “breathprint” of 17 diseases. ACS Nano. Retrieved from https://newatlas.com/different-diseases-different-breathprints/47088/

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Hi Janice, thank you for your reply! I do feel that nurses' giving nature can be a source of our collective downfall when it comes to power in the workplace, bargaining, and issues with hostility. However, this is an asset in our care of our patients. The poll results show that it does matter. It remains to be seen if nursing continues to uphold such an honor from the American public, but a 15 year record is admirable!

-Erin

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Thank you for your reply! I liked the article as well, as it did tie in the outpatient and primary care environments. I'm sure we are all familiar with taking a history from patients and feeling frustrated with lack of detail or confusing timelines. I also think there is a fundamental difference sometimes in what patients see as important, and what we want to know, clinically. While the patient's feedback and concern is obviously important, wearable devices could help gather the more clinical side of data that can be added to the whole picture. Thanks for your reply- glad you liked the article!!

-Erin

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3 reasons why nursing is the most trusted profession

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A recent Gallup poll showed that Americans perceive nurses to be the most honest and ethical profession. (Video Sarah Corsa) http://www.reviewjournal.com/life/health/nurses-rank-the-highest-earning-our-trust-poll-shows-video

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Response #1 to questions
1. Yes, I do believe that nurses will continue to take the #1 place in the poll. According to Gallup, nurses have taken the #1 position every year since 1999 except for 2001. 2001 was the year that firefighters were added and that was when 9/11 occurred. Nurses impact everyone's life and almost all interactions are positive. There are obviously some bad interactions as well, but those are not as frequent. Nurses take care of people in offices and in the hospital when people are usually having the worst time of their life. Doctors come and go so infrequently that the nurses are the ones that patients will always remember.  The attached article discusses the information about how nurses are the most trusted profession.

Chris
You are correct, we always have been THE patient advocate. As nurses we surpass other levels of relationships. Patients tell us the stories that they do not tell anyone else. We are trusted and as such it is incumbent upon us to become their advocates and their confident.
Manny

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Story Highlights

Nurses rated highest among professions for 15th straight year

College teachers' ratings dropped

41% say journalists' standards are "low" or "very low"

​WASHINGTON, D.C. -- Most Americans trust their healthcare providers to be honest and ethical, but few other professions fare so well in Gallup's annual look at honesty and ethical standards among various fields. Nurses top the list with 84% of the public rating their standards as "high" or "very high," while members of Congress fall to the bottom -- the only profession for which a majority of Americans (59%) rate honesty and ethical standards as "low" or "very low."

Nurses have topped the list every year but one since Gallup first asked about them in 1999. In 2001, Gallup included firefighters in the list based on their heroic efforts in the wake of the 9/11 terrorist attacks, and 90% of the public rated their honesty and ethical standards as "high" or "very high."

A majority of Americans viewed only six of the 22 professions Gallup measured in its Dec. 7-11 poll as having "high" or "very high" ethical standards. For 10 of those professions, fewer than one in five Americans rated the standards as "high" or "very high" -- including key aspects of American society such as lawyers, lawmakers and business executives.
College Teachers' Rating Falls Below 50%
College teachers' honesty and ethical standards rating dropped to 47% this year from 53% in 2012. The first four ratings for college teachers, conducted between 1976 and 1983, were below 50%, bottoming out at 42% in 1977. The rating rose to 53% in 1985 and stayed above 50% in all but one of the next 18 polls through 2012.

The percentage of Americans saying college teachers' standards were either "low" or "very low" reached a new high of 18%, surpassing the 11% recorded in 2009.

Ratings of college teachers showed strong partisan differences, with 33% of Republicans giving them a "high" or "very high" rating, compared with 63% of Democrats.
More Americans Rate Journalists' Standards as "Low" or "Very Low"
The 23% who rated journalists' honesty and ethical standards as "high" or "very high" this month is within a few points of the 20% who rated it "high" or "very high" in 1994. The percentage saying their honesty and ethical standards were "low" or "very low" climbed to 41%, 10 percentage points above the previous high of 31% measured in 2008 and 2009. In previous polls, more Americans rated journalists' standards as "average."

Twenty-one percent of Democrats rated journalists' honesty and ethical standards as "low" or "very low," compared with 63% of Republicans.
Ratings of Clergy's Honesty and Ethical Standards Continue Slow Descent
Americans' "high" or "very high" ratings of the clergy slipped to 44%, its lowest point since Gallup first asked the question in 1977. The clergy rating first dropped below 50% in 2013 to 47% and slipped one point to a new low in each of the past three years.

Clergy ranked at the top of the list in 1977 with a 61% rating when Gallup first included the profession in the list. In 2001, almost two-thirds of Americans rated the honesty and ethical standards of the clergy as "high" or "very high." But the sexual abuse scandal that engulfed the Roman Catholic Church in 2002 brought the rating down to 52% that year. By 2013, after a series of further revelations of abuse, less than half of the public gave the clergy a "high" or "very high" rating.

Among those most likely to give the clergy a "high" or "very high" rating this month were Protestants (59%), those aged 65 and older (58%), those who attend religious services at least weekly (57%), and Republicans (56%).

The groups least likely to rate the clergy's standards as "high" or "very high" were the nonreligious (22%), 18- to 29-year-olds (30%), those with annual household incomes under $30,000 (31%), those with a high school education or less (37%), and liberals (37%).
Bottom Line
Healthy majorities of the American public continue to show a willingness to trust the honesty and ethical standards of healthcare providers -- nurses, doctors, pharmacists and dentists. However, Americans do not, by and large, rate the honesty and ethical standards of American professions highly.

Further, for the fourth year in a row -- in a nation where religion is an important part of life for three-fourths of the population -- less than half of Americans think religious leaders have high ethical standards. Meanwhile, two groups of professionals linked to the bitter political battles of 2016 -- college teachers and journalists -- are at or near their all-time lows, with views split along partisan lines.

As Americans consider how much to trust the honesty and ethical standards of many of the country's major professions in the next few years, politics may be a major factor. With the public expecting President-elect Donald Trump to make major changes to the federal government, the fierce political battles to come could produce a litany of charges of dishonesty and corruption. Trump is already embroiled in controversy concerning what should happen to his business holdings, and that may turn out to be a precursor to the ethics charges and countercharges that lie ahead.
Survey Methods
Results for this Gallup poll are based on telephone interviews conducted Dec. 7-11, 2016, with a random sample of 1,028 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

Each sample of national adults includes a minimum quota of 60% cellphone respondents and 40% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.
View survey methodology, complete question responses and trends.
Learn more about how the Gallup Poll Social Series works.

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Americans Rate Healthcare Providers High on Honesty, Ethics

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Story Highlights Nurses rated highest among professions for 15th straight year College teachers' ratings dropped 41% say journalists' standards are "low" or "very low" ​WASHINGTON, D.C. -- Most Americans trust their healthcare providers to be honest and ethical, but few other professions fare so well in Gallup's annual look at honesty and ethical standards among various fields.

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1. Do you believe nurses will continue to take the #1 place in the Gallup Poll as the most trusted profession? Why or why not?
With the increased need for nursing and the growing numbers of people entering into the profession, it seems that nursing will remain in the top position, but it is certainly not a sure thing. However, that being said, nuring profession ranks high in honesty and ethical standards for Gallup and that for many people is enough to supply them with the security and comfort they need to place nursing in the top slot. Nursing.Org (2017), quotes a growth in jobs around 16% for general nursing and 31% for advanced practice, verses physician growth of 14% (para 12).  As nursing staff are considered to be a valued commodity to employers and patients there seems to be no reason to not think that nursing would remain in the top position.

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The Gallup Poll, Healthcare, and Nurses' Reputation

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Nurses earn top ranking in the latest Gallup poll on ethics and honesty. Find out what this means for the future of healthcare.

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Response #3

I work at the UW in the GI specialty clinic. One concern is getting correct and accurate information from patient with Crohn's of UC flares. A new technology that came out in 2016 from Takeda, was a watch that can track IBD symptoms.  This would help patients track symptoms especially when you usually do not treat right away.  People can forget what happened two or three weeks ago.  It would be nice to have something that can be more accurate.  Especially for patient with UC who can sometimes under report and can end up hospitalized because they do let their symptoms go to long.  See website below:
https://www.takeda.com/newsroom/featured-topics/digital-innovation-for-better-disease-management-in-inflammatory-bowel-disease-ibd2/

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A big ethical and legal issue in informatics is HIPAA compliance.  The EMR makes accessing patient information much easier.  Organizations have policies about employees accessing health records of patients not in their care, other employees, and even their own records.  Some staff do not realize that everything they do within the EMR is tracked and auditable.  I have been involved in many cases in which I am asked for key stroke reports of users showing charts they accessed and what information within the chart was accessed.  The EMR team is responsible for determining the correct access levels for different staff.  For example, unit clerks do not need to access vital signs or a patient’s medication record, so it is locked down at our organization.  Based on job roles, access is granted or limited (“Summary of the HIPAA Privacy Rule,” n.d.).  This helps to prevent a privacy breach of patient information.

Reference

Summary of the HIPAA Privacy Rule. (n.d.). Retrieved from https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html

Natalie Peleg

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In response to the article titled "Advances in Wearable Technology and Applications in Physical Medicine and Rehabilitation." This was a great article and read to explain how these wearable devices really aid in the continuation of care. It is often hard to paint the entire clinical picture upon sporadic appointments, with limited verbal symptom descriptions from the patient. However, as mentioned in the article these wearable devices are, “Likely to be complementary to outcome measures, the use of wearable systems in the clinical management of individuals undergoing rehabilitation is very attractive because it provides the opportunity of recording quantitative data in the settings that matter the most, i.e. the home and the community” (Bonato, 2005). Through the advances of these wearable devices providers are able to make direct observations concerning the impact of clinical interventions on things like mobility, level of independence, and quality of life. This was a very good article toward pointing out the benefits of wearable devices in healthcare.

Regards, Kaitlyn Morris

Reference

Bonato, P. (2005) Advances in Wearable Technology and Applicationsin Physical Medicine and Rehabilitation. Journal of NeuroEngineering and Rehabilitation. Retrieved from https://doi.org/10.1186/1743-0003-2-2

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Good morning Erin and Menachem!
Again, great Padlet this week and good questions!

2. Explore one Pro or positive use and one Con or negative use of a new technological advancement- wearable trackers/monitors, biosensing garments, Google Glass, etc.

I think that one pro to wearable trackers is that it allows the patient to take charge in their own healthcare and treatment. They are able to track their trends and be an active participant in their care, seeing what works and what does not work, or better understand why a physician is choosing their plan of care based on these readings. I think that a con, like most things would be compliance related. Some patients may not want to wear such devices at all times, especially during physical activity or during sleep etc. I know that when I sleep I do not want anything on me to be most comfortable and relaxed, or just that the patient doesn’t fully understand the importance of being compliant with wearing such devices at all times, and approach it in more of a relaxed manner.

3. What new medical technology have you heard of that would be exciting to implement in your field of practice? Are there any associated ethical issues? As a Labor and Delivery nurse oftentimes if a patient has a higher BMI, wants to ambulate, or is just plain difficult to get an appropriate fetal and contraction reading by external monitors, we as nurses are continuously in the room making adjustments, the patient is uncomfortable and the calm, labor environment is continuously disrupted by making failed attempts to get accurate readings. There has been the introduction of wireless, strapless, external monitors, supposedly to cater to the bariatric as well as patient population who wishes to ambulate during labor. We have had numerous representatives comes to our unit to explain the product, however when testing the device on our unit there were a few glitches and we were unable to obtain an accurate reading with the device. We also found some issues with the Bluetooth/wireless connection. I would love to see technology such as this make advancements toward success, as I feel this benefits the patient drastically but also the healthcare provider.

Regards, Kaitlyn Morris

Reference

Accardie, A. (2016). How Biosensing Wearable Technology is Revolutionizing the Healthcare Industry- Part 1- Types of Wearables. Engagemobile. Retrieved from http://www.engagemobile.com/how-biosensing-wearable-technology-is-revolutionizing-the-healthcare-industry-part-1/

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Response # 1 to Mrs. Shepherd and Mr. Czarka

Mrs. Shepherd and Mr. Czarka thank you for your creative and informative Padlet titled “Legal and Ethical Issues in Informatics.”  Nursing is the profession that provides services to people in their most vulnerable moments of their lives.  In such moments, nurses have the responsibility to not only serve but also to protect the rights of those under their care.  The nursing profession will always be valued as important, since it is the one who advocates for patients rights.  It is the responsibility of nursing leaders worldwide to safeguard as well as maintain the integrity of this caring, compassionate and sometimes misunderstood profession.  Referring to your first question, the nursing profession will always be valued as the most trusted profession, if nursing leaders are diligent in preserving its integrity and enforcing guidelines/statutes that will prevent its degradation.  As noted by Sewell (2016), “professional nursing associations worldwide have established codes of ethics.  They all address principles and values of ethical practice, although the exact wording may vary slightly” (p. 388).

In regards to your second question, one innovative mobile cardiac telemetry system device created by the company Medtronic is SEEQ.  This device is described as a peel and stick wearable sensor that is worn on the chest area.  The sensor monitors the heart rhythms and sends this information through a hand-held device to the Medtronic Monitoring Center.  Some of the benefits are that it is wireless, the patient wears it for a period of thirty days and the device is discreet.  It provides much more information than the twenty-four hours Holter monitor.  One of the concerns of using a third party to monitor a patient’s medical status information is the accessibility given to this third party to the patient’s private health records.  It increases the vulnerability of possible violations to the patient’s private medical record information.  According to Ozair, Jamshed, Sharma and Aggarwal (2015), “security breaches threaten patient privacy when confidential health information is made available to others” (p. 74).

In my current place of employment, patients who undergo spinal fusion are expected to use a device named Bone Growth Stimulator.  The company Orthofix makes the device.  This company has created an app that can help patients and the surgeons track the amount of time the device is utilized.  It is described as “tracks real-time usage data.”  Through the app, the patient allows the company to have access to his/her smartphone to provide the real time usage data information.  Any time you allow a third party access to your private devices it makes you vulnerable to possible violations.

References
Jamshed, N., Ozair, F., Sharma, A., & Aggarwal, P. (2015). Ethical issues in electronic health records: A general overview. Perspectives in Clinical Research, 6(2), 73. doi:10.4103/2229-3485.153997

Sewell, J. (2016). Legal and ethical issues. In Informatics and Nursing: Opportunities and Challenges (5th ed., pp. 387-399). Philadelphia, PA: Wolters Kluwer

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Good evening! Great job Erin and Menachem on your Padlet this week, very though provoking questions. To answer question number one I actually had to research Gallup Poll, and it honestly made me feel proud that nurses are considered the most trusted profession, even more so than teachers or firefighters!

1. Do you believe nurses will continue to take the #1 place in the Gallup Poll as the most trusted profession? Why or why not? Yes, I believe that nurses as well as other healthcare providers will continue to remain at the top of the Gallup Poll as the most trusted profession. I feel that while this is largely due to the ethical and privacy protocols that we have in place, nurses from the beginning of nursing school, to job and unit orientation are taught about how important HIPPA is and the detrimental effects that violating such a code can have on your license. However, barring legal implications, I think nurses also genuinely want to protect the privacy of their patients and gain their trust, we did chose this profession to care for our population and with that I think comes a deeper sense of compassion when compared to other professions.

Again, great question!
Regards, Kaitlyn Morris

Reference

Norman, J. (2016). Americans Rate Healthcare Providers High on Honesty, Ethics. Gallup News. Retrieved form http://news.gallup.com/poll/200057/americans-rate-healthcare-providers-high-honesty-ethics.aspx

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Response #2

Explore on Pro or Positive use and one Con or negative use of the new technological advancement-wearable trackers/monitors, biosensing garments, google glasses, etc.

This is a great question and one I now a little about. When we first opened the DHC at UW we were one of the first buildings to use these trackers you wear. It was to be used to track wait times, staff and patient locations. It did show wait times and did help with tracking staff if they wore the device. The problem was that some physicians had ethical and religious reasons for not wearing them. Some patients found them offensive. It did help with dashboard evidence and pulling information and data to improve wait times and RFID tags are being used on equipment as well to track where it is.  This can help patient safety. RFID are used to do capsule endoscopes on patient to see if they have any internal bleeding (see website listed below). This is the positive side where it can dx and possibly save lives. Great and in-depth question. Thanks.

https://uconnect.wisc.edu/depts/uwhc/clinical-engineering/rfid-tags/how-tagging-items-has-increased-patient-safety/

https://uconnect.wisc.edu/clinical/pted/hffy/dhc/7848.hffy

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1. I think that no matter what, nurses will remain top-ranked on the Gallop Poll and I personally like Carlson’s (2017) reasoning: “No one can presume to predict how long nurses will enjoy top ranking when it comes to public opinion regarding the profession, its ethics, and the important work that nurses do. However, with the undeviating growth of the healthcare sector and the continued projection of nursing’s expansion in both raw numbers and intrinsic value to American healthcare, Gallup will be sure to see nurses retaining a high level of the American public’s trust and positive regard,” (Gallup and the Future of Nursing section, para. 1).

2.  The Moffitt Cancer Center (2017) noted that one of the positives of wearable technology is that most patients claim to wear the tracking device constantly, except when the device is charging. One of the cons noted by the Moffitt Cancer Center (2017) was that patients reported when they forgot to wear their device they were less apt to work out, because they would not receive “credit” for their activity (The Cons section, para. 1).

3. I work in the GI specialty and I found a new medical technology called “Breathprint” that would be very exciting to utilize in our clinic. Karban et al. (2016) designed Breathprint to analyze collected breath samples from patients to then determine whether a patient is healthy, versus having Irritable Bowel Syndrome (IBS) versus having Inflammatory Bowel Disease (IBD), in a manner that is cheap, reproducible and easy-to-use. This would save so much money for unnecessary labs and procedures (such as colonoscopies) and would really maximize efficiency of our clinic because differentiating a patient’s diagnosis could be completed before a patient is even seen in the clinic. This would also ensure that the correct patient is scheduled for their follow-up (if necessary) with the correct GI specialist. I will have to speak to my providers to see if they’ve heard of this, but the results are promising, showing 81% accuracy between IBD and IBS and 75% between Crohn's and Colitis (the two types of IBD) (Karban et al., 2016, p. 2342).

I do not see any ethical issues with this technology, it would work like any other lab ordered by the GI provider.

Resources

Carlson, K. (2017, January 22) The Gallup Poll, healthcare, and nurses’ reputation. Retrieved from https://nurse.org/articles/gallup-ethical-standards-poll-nurses-rank-highest/.

Karban, A., Nakhleh, M., Cancilla, J., Vishinkin, R., Rainis, T., Koifman, E., . . . Haick, H. (2016). Programmed nanoparticles for tailoring the detection of Inflammatory Bowel Diseases and Irritable Bowel Syndrome Disease via Breathprint. Advanced Healthcare Materials., 5(18), 2339-2344. doi:  10.1002/adhm.201600588

Moffitt Cancer Center (2017, January 18).  The pros and cons of fitness trackers. Retrieved from https://moffitt.org/take-charge/take-charge-story-archive/the-pros-and-cons-of-fitness-trackers/.

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Great job on your Padlet!

I believe nurses will always be top ranked, but not necessarily continually at #1.  Certain events tend to alter the public’s view, such as September 11th.  In the 2001 Gallup Most Trusted Professions, firefighters beat out nursing for the top spot, a well-deserved rank.  Since then, nursing has taken the #1 spot for the last 15 years.  I think nursing will continue to rank high on the poll simply because of what our profession stands for and how we are viewed by our community and the public.  Our profession treats people no matter their medical coverage, ability to pay for care, gender, sex, and religion to name just a few.  Nursing does not play middle man and we treat the patient as a person.

Application-integratable devices have many advantages for patients.  Blood pressure cuffs can now sync with smart devices and track information within an application.  It is then relayed to a patient’s health care provider to monitor and intervene if needed.  Now, CHF patients do not need to necessarily physically visit their provider and can instead use electronic communication regarding their health.  One of the downsides of these devices and applications is data sharing and storing.  There have been many conversations regarding the ethics of storing this data and using it later for research.  Does the patient give consent for the use of their information when they consent to use the device?  Should separate consent need to be given?  Despite laws and regulations, uncertainties remain surrounding patient consent (Haynes, Cook, & Jones, 2007).  While patients consent to hospitalizations and medical and surgical interventions, their consent is not explicitly given for their data to be dumped into a data repository.  Though all patient identifiers are supposed to be removed to protect confidentiality, the amount of data collected still poses risk.  There should always be a risk-benefit analysis.  These questions have strong reasons on both sides and as the technology develops and advances, I believe we will see more of this debate.

I think any application related to population health would be an exciting implementation.  There are a variety of applications available to assist patients with their medical care.  One application has medication and health maintenance reminders for the patient.  If the patient dismisses the reminder after a predetermined number of times, or hasn’t logged an activity, an alert can also be triggered to their care giver.  This engages the patient and their family to take an active role in their medical management plan.  Data storage and exchange related to security and privacy could be a potential issue.

Reference

Haynes, C. L., Cook, G. A., & Jones, M. A. (2007). Legal and ethical considerations in processing patient-identifiable data without patient consent: Lessons learnt from developing a disease register. Journal of Medical Ethics, 33(5), 302–307. doi:10.1136/jme.2006.016907

Natalie Peleg

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Healthcare Informatics use is on the rise. Providers and patients have access to patient’s information by simply logging in to a computer, no matter how remote that computer is. At first it seems that there’s limited connection between informatics and ethics, but when one digs in one can see a clear distinction and connection between the two. “Ethics is the art of behaving.” (Hatieganu, 2016, p. 91) Health Informatics “is the scientific field dealing with resources, devices, and formalized methods for optimizing the storage, retrieval and management of biomedical information for problem solving and decision making”. (Hatieganu, 2016, p. 92)

It seems clear that it is important to behave in an ethical way when using informatics in healthcare. There is a proper way “legal and ethical way” use software when disclosing of patients’ information, diseases and risks. Whenever sharing data amongst providers or other healthcare organizations there must be handled safely, and there must be practice guidelines to avoid conflicts or even damages. (Hatieganu, 2016) Professionals who are using informatics must be trained on a regular basis. A clear set up of guidelines and legal regulations must be reviewed at least once a year to prevent errors.

A Code of Ethics related to healthcare informatics was created in 2002 and it is international. It defines the importance of data protection and can be easily accessed online in several languages. It provides guidance for the professionals, principals of conduct and provides the public with a clear statement of ethical consideration that providers must follow. (Hatieganu, 2016)

Carolina Guimaraes, RN-C

Bibliography

Hatieganu, I. (2016). Ethics and Legal Considerations of Healthcare Informatics. Applied Medical Informatics, 38(34), 91-98.

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Janice,Thank you so much for your post and reminding us about our priority to our patients. Nurses are considered as the patient advocate, and as the individuals that most patients divulge information with while they are in the health care setting. As nurses we gain patients trust because we are nurses, because we share the birth of a baby, childhood illnesses, celebrating the success of a patient’s recovery from surgery, oncological treatments, and holding the hand of a dying patient.  Yes we are professional and we are human. Yes, the public trusts us because we are nurses and trust is where all starts. Manny

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Janice,Thank you so much for your post and reminding us about our priority to our patients. Nurses are considered as the patient advocate, and as the individuals that most patients divulge information with while they are in the health care setting. As nurses we gain patients trust because we are nurses, because we share the birth of a baby, childhood illnesses, celebrating the success of a patient’s recovery from surgery, oncological treatments, and holding the hand of a dying patient.  Yes we are professional and we are human. Yes, the public trusts us because we are nurses and trust is where all starts. Manny

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Response #1

Do you believe nurses will continue to take the #1 place in the Gallup Poll as the most trusted profession? why or why not?
So I had to look this up and yes I think in honesty and ethics which is what they were basing this poll on that nurses will continue to be rated #1. Even with social media access to information and the internet providing Web MD and others. Being named number one for the past 15 years should be an honor from a list of 22 professions. I think that nurse value the code of ethics that the American Nurses Association (ANA) has addressed in all nursing education training (Sewell, 2017).  Nurses get into the profession to help people and at times it is a thankless job.  Getting the credit and the doctors and so the nurses have a tendency to be giving in nature in their personalities and also trustworthy.  Great questions and good job on the Padlet you too!!

References
Sewell, J. (2016). Informatics and Nursing: Opportunities and challenges (5th ed.). Philadelphia, PA: Walters Kluwer.

Williamson, E. (2016).,
Nurses rank #1 once again Gallup poll for ethics and honesty., Nurses.com Retrieved from: https://www.nurse.com/blog/2016/12/21/nurses-rank-1-once-again-in-gallup-poll-for-ethics-and-honesty/

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Here is our paper on the subject. Happy reading!

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1. Do you believe nurses will continue to take the #1 place in the Gallup Poll as the most trusted profession? Why or why not?
2. Explore one Pro or positive use and one Con or negative use of a new technological advancement- wearable trackers/monitors, biosensing garments, Google Glass, etc.
3. What new medical technology have you heard of that would be exciting to implement in your field of practice? Are there any associated ethical issues?

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Advances in Wearable Technology and its uses in medicine

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Advances in Wearable Technology and its uses in medicine

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https://jneuroengrehab.biomedcentral.com/articles/10.1186/1743-0003-2-2

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Apple is delving further into heart monitoring, attempting to alert patients to abnormal rhythms and offering free testing if one is detected.

https://www.theverge.com/2017/11/30/16719458/apple-watch-study-irregular-heart-rhythms-stanford-university

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In an aging population with rapidly increasing technological interventions possible, end of life care is a vital discussion. With multiple perspectives to consider, these resources serve to convey the breadth of opinion that nurses experience, and help nurses respect individual dignity and autonomy.

Advance directives

End of life care often starts when a person is healthy. Many people, including nurses, have specific ideas about what health care they want, or do not want, at the end of life. Advance directives are a means to allow people to convey their wishes for end of life care. This includes discussions with those who might be a surrogate decision maker, as well as documents used to express preferences.

The National Hospice & Palliative Care Organization (NHPCO)
HHPCO has a directory of advance directives that are acceptable to each statue.

Five Wishes
An easy guide for patients and families to discuss preferences for end of life care, as well as for healthcare professionals who might not be comfortable with such discussions. The guide includes prompts for discussions about how you wish to be remembered.

Education

The End-of-Life Nursing Consortium (ELNEC)
ELNEC is a series of programs developed by the American Association of Colleges of Nursing. Current ELNEC modules include core curriculum, pediatric palliative care, geriatric, and many others. There are also train-the-trainer modules. After taking a train the trainer course, a nurse can then offer an ELNEC course. The courses are comprehensive and provide all teaching materials needed. The courses are typically offered in a block over two days.

Education in Palliative and End of Life Care (EPEC)
EPEC was originally developed as physician education but has expanded. It has both in-seat and online programs. The model includes the training of facilitators. Sessions may be given in day-long formats, or in shorter sessions, such as grand rounds.

Professional Organizations

The Hospice & Palliative Nurses Association (HPNA)
HPNA has the mission of advancing expert care in serious illness. HPNA is the professional organization for palliative care nurses and hospice nurses. HPNA provides education and certification for nurses across levels, including Advance Practice Registered Nurses (APRN), Registered Nurses (RN), RN Pediatrics, and more. HPNA has many Special Interest Groups (SIGs) with online discussion groups. The organization has also developed a series of position statements to guide professional practice. With The American Academy of Hospice & Palliative Medicine (AAHPM), HPNA has an annual assembly for professionals.

The American Academy of Hospice & Palliative Medicine (AAHPM)
AAHPM is the professional organization for hospice physicians, palliative medicine physicians, and other health care professionals (nurses, social workers, chaplains, etc.) in these fields. Their goal is to improve the care of patients living with serious illness. AAHPM provides certification for physicians in palliative medicine, as well as for hospice medical directors. AAHPM provides many options for education, online discussion groups, special interest groups, and certification. With HPNA, AAHPM has an annual assembly for professionals.

The Center to Advance Palliative Care (CAPC)
CAPC is a multidisciplinary organization that supports practice, research, and education. Hospitals can become member organization, and all employees of those organizations have extensive access to continuing education and other resources. Even non-members have access to the myriad resources of CAPC.

The National Hospice & Palliative Care Organization (NHPCO)
NHPCO is one of the oldest advocacy organizations in the fields of hospice and palliative care. Their focus is primarily on the care of patients with terminal illness, and their families. They have developed Standards of Practice and have several position statements.

Growth House
Growth House's mission is improving care for the dying. They provide education about living with serious illness and end of life care. Their education is for lay people (including the very popular Handbook for Mortals) and healthcare caregivers (e.g. the Stanford Curriculum for end of life care), as well as disease specific education on topics such as heart disease, end stage renal disease, and cancer.

The Schwartz Center
The Schwartz Center is another organization whose goal is to improve the care of patients who are dying. One of their best known efforts is Schwartz Center Rounds, which are intended as a regularly scheduled forum for caregivers to discuss the challenges of caring for patients and families. Schwartz Center Rounds are currently held in about 550 centers in the U.S., U.K., and Canada.

Hospice

Hospice is a model of care for people who are at the end of life. Specifically, hospice care is eligible for people who are estimated to have a prognosis of six months or less. Hospice is tremendously underutilized, with about 50% of patients having a length of stay of less than 18 days, as opposed to the approximately 180 days of the hospice benefit. Misperceptions about hospice are common. A common misunderstanding is that hospice is a place ("She's going to hospice"), rather than a model of care. Greater than 90% of hospice care occurs in patients' homes.

The Centers for Medicare and Medicaid Services
This resource explaining the hospice guidelines is helpful for patients, families, and providers.

Elder Law Answers
This resource from Elder Law Answer is used to make the Medicare Hospice Benefit more comprehensible.

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Life and death decisions are a part of nursing, and ethics are therefore fundamental to the integrity of the nursing profession. Every day, nurses support each other to fulfill their ethical obligations to patients and the public, but in an ever-changing world - there are increased challenges.

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The following stories that were presented on this video are based on true events.

FYI: Video is being served for educational purposes only.

Case #1, entitled, Medical Record for Sale

"On May 14, 2013, federal prosecutors charged one of the hospital's medical technicians with violating the Health Insurance Portability and Accountability Act (HIPAA). Prosecutors said that over a 17-month period, Laurie Napper used her position at the hospital to gain access to patients' names, addresses and Medicare numbers in order to sell their information. A plea hearing had been set for June 12, 2013 in which she was found guilty and sentenced for 6 months in a half-way house and fined $2,100. "
- quoted from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394583/
Case #2, entitled, MR Wholesaler

"A few weeks earlier, the same hospital informed more than 34,000 patients that their medical data had been compromised. A contractor working with the hospital had downloaded the patient's files onto a personal laptop, which was stolen from his car. The data were password protected, but unencrypted, which means anyone who guessed the password could have accessed the patient files without a randomly generated key. By encryption, we mean encoding of information in such a way that only authorized parties can read it. It is usually done with the help of encryption key, which specifies that how the information should be decoded. According to a hospital press release, those files included names, addresses, and Social Security numbers and in a few cases, "diagnosis related information". Recently a hospital chain named Prime Health care Services Inc. has agreed to pay $275,000 to settle a federal investigation into alleged violation of patient privacy. Keeping records secure is a challenge that doctors, public health officials and federal regulators are just beginning to understand. Cloud storage, password protection, and encryption are all measures health care providers can take to make portable EHRs more secure."
- quoted from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394583/
Case #3, entitled, Text Me if You Can

A survey conducted found that 73% of physicians text other physicians about work. Mobile devices are for individual use and are not designed for centralized management by an IT Department. Mobile devices can easily be misplaced, damaged, or stolen. Emphasis must be laid on encrypting mobile devices that are used to transmit confidential information. Portable EHRs can be made more secure by using cloud storage, password protection, and encryption. Usage of two factor authentication system with security tokens and password are helpful in securing EHRs.
- quoted from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394583/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394583/
Video edited from Powtoon
ethical issues in health informatics, ethics issues, featured, health informatics philippines, hi201, mshi

By MariaDP
Clinical Data Analysis Manager * Clinical Systems Analyst * Nurse Informaticist * Graphic Designer * Master of Science in Health Informatics at University of the Philippines

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masters in health informatics philippines

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The following stories that were presented on this video are based on true events. FYI: Video is being served for educational purposes only. Case #1, entitled, Medical Record for Sale "On May 14, 2013, federal prosecutors charged one of the hospital's medical technicians with violating the Health Insurance Portability and Accountability Act (HIPAA).

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Technological Advances

If you'd told me twenty years ago I would have a handheld device that knows the weather in a city thousands of miles away, then I would've called you crazy. But this is the technological evolution that has occurred within the past two decades! These technological advances have not only impacted our social spheres and workplaces, but even our healthcare.

The age of electronic health records has dawned. Most likely when you enter an emergency room or the doctor's office, you will encounter someone entering your personal health information into a computer. Has typing simply replaced handwriting, or are there advantages that the digital age can bring to medicine that are, as of yet, unexplored?

Communal Health Information Exchange

Electronic health records (EHR), or a digital record of a person's health history, are common, but remain highly individualized to the hospital or practice utilizing them. That is to say that each healthcare entity has its own EHR system, but these systems do not readily communicate with one another. The potential for intercommunication between healthcare professionals using a communal EHR system is huge.

For example, let's follow Dot through her week. On Monday she sees her cardiologist, who checks her blood pressure, orders some lab work and refills her blood pressure lowering prescription. On Wednesday, Dot goes to her urologist, who checks her urine, orders some lab work, and refills her urinary incontinence medication.

Okay, so as it stands it's up to Dot to communicate what her cardiologist is prescribing and performing to her urologist and vice versa. What if Dot had a centralized EHR to which both her cardiologist and urologist had access? This would ensure that the medications she is taking do not interact, no redundant lab work is ordered, and all the healthcare providers caring for Dot are on the same page.

Now, let's say Dot trips and falls, necessitating a trip to the hospital. Who is going to inform the hospitalists of which medications and health conditions Dot has? Well, this proves the value of a centralized EHR. Despite the primary information source (Dot) being unavailable, medical professionals would still be informed of Dot's health history through this communal health information exchange system.

Improving Diagnostic Accuracy

Another future trend for EHR includes improving diagnostic accuracy. If an EHR can provide a central place for clinical data, such as lab work results and imaging studies, then when a clinician is attempting to diagnose a problem he will have all the pertinent information at his fingertips.

Also, imagine if when a healthcare provider is formulating a list of differential diagnoses, EHR could recommend a suggested diagnosis based off of the most current evidence. With the capabilities of being abreast of thousands of medical journals, EHR could facilitate the healthcare provider in reaching the correct diagnosis. Furthermore, this same service could help recommended the most up-to-date treatments and therapies for a given diagnosis.

Increasing Patient Autonomy

EHR increases patient autonomy or the potential for a patient to be actively involved in his care. As of yet, this potential remains underdeveloped, but future trends suggest this could be changing. Entry of basic personal data, - such as name, address, birth date - could be entered directly by the patient and engineered into a repeating template so this information is not requested at each visit to a provider.

In addition to helping input information, patients will have access to their own information. Thus, EHR offers a way for patients to share private health information with family members. For example, Dot can show her son a list of her current medications to ensure he picks up the correct ones from the pharmacy. Increasing awareness among family members is possible with EHR and is critical in orchestrating a patient's care.

Lastly, EHR provide a valuable outlet for patient education. The internet is a vast place which simply can be overwhelming when searching for medical advice. Within EHR, healthcare providers could provide educational resources for patients and their family members that are specific to the patient's diagnosed conditions.

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electronic health records: future trends - video & lesson transcript | study.com

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Electronic Health Records: Future Trends - Video & Lesson Transcript | Study.com

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If you'd told me twenty years ago I would have a handheld device that knows the weather in a city thousands of miles away, then I would've called you crazy. But this is the technological evolution that has occurred within the past two decades!

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Ethical issue of our time. Young Chan Kim

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Arkansas State University CIT 3013-003 By Brandon mason

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Created using PowToon -- Free sign up at http://www.powtoon.com/youtube/ -- Create animated videos and animated presentations for free. PowToon is a free tool that allows you to develop cool animated clips and animated presentations for your website, office meeting, sales pitch, nonprofit fundraiser, product launch, video resume, or anything else you could use an animated explainer video.

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Healthcare Informatics Overview

Kingsley, a registered nurse with a keen understanding of computers and healthcare, has joined the implementation team for a new electronic health record. His team has addressed ethical and legal issues with this new technology. Developing policies and procedures for staff and physicians to use in this new technology will guide safe and secure healthcare information in the facility.

Healthcare informatics is a design of communication, information, and documentation in an electronic health record (EHR). It's necessary to work through legal and ethical issues before the purchase of this technology ever occurs. A successful go-live or launch of this technology depends on the team and the type of software chosen.

Let's now take a look at some of the legal issues found in healthcare informatics.

Law in Healthcare Informatics

1. Protecting Health Information

It's required by law to handle all patient health information with confidentiality, meaning no one should have access to the patient's health record unless they're actively caring for that patient and they should never share information with someone outside the patient care team. The cost of breaking confidentiality is high. Disciplinary action within the organization, lawsuits, fines, and professional regulatory body disciplinary actions, from state boards of nursing, for instance, may occur. Security extends from the confidentiality of the patient's record to the actual cyber security of the hospital's informatics systems. Keeping hackers out is a huge concern for both patients and organizations. Social networking is another area of concern. Kingsley's team has produced a strong social media policy to keep patient information secure.

2. Health Information Technology Vendors

In 2016, over 4,000 healthcare facilities were using software or health information technology (HIT). This is an ongoing relationship between vendors and healthcare organizations. Strict guidelines must be followed by law for the HIT to be accepted by Medicare and receive payment for services rendered. The EHR must be certified as capable of handling the information and communication needs, provide security for patients' information confidentiality, and be functional for staff and providers, including standardized care plans. Kingsley's team will meet with several companies to choose the right health record.

Here are some vendors considerations that are usually taken into account:

A good fit for the staff and providers for a long-term contract

Flexibility of the vendor to meet the organization's needs, since things can change quickly

Partnership with the same quality and safety goals as the organization

Complete training and support package meeting staff and physician needs throughout implementation and transition

Ability to provide needed data collection tools, training, and design flexibility

Security in place for EHR software and interface or communication with other programs

Clear and concise curriculum for trainees to learn new technology

3. Healthcare Informatics and Patient Safety

A core responsibility of healthcare technology is to build the workflow with the patient's safety in mind. At every decision point, there is error vulnerability for staff and patients. The design of the EHR must provide information and knowledge links in the record for staff, such as information about medication ordered. The vendor, organization, and provider must have common goals to keep the potential for errors low by decision-support, a built-in alert and guidance system to catch errors before they happen.

Kingsley has brought patient identification and accurate medication barcoding to staff in advance of the new technology. Every patient must have an armband with barcodes and every medication must also have barcodes to scan prior to giving medications. Safety alerts can pop up to prevent errors at this time.

The EHR needs to be easily understood, clearly visible, accessible, and organized for documentation and finding needed information about the patient quickly.

Ethics in Healthcare Informatics

As healthcare informatics continues to grow, increasing ethical concerns need to be addressed. First, protecting patient confidentiality will require a strong policy and procedure securing patients' health records. Electronic surveillance must be in place to monitor who has access, and who accessed the records.

Here are some aspects of ethical issues in healthcare informatics:

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ethical & legal issues in healthcare informatics - video & lesson transcript | study.com

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Ethical & Legal Issues in Healthcare Informatics - Video & Lesson Transcript | Study.com

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Kingsley, a registered nurse with a keen understanding of computers and healthcare, has joined the implementation team for a new electronic health record. His team has addressed ethical and legal issues with this new technology. Developing policies and procedures for staff and physicians to use in this new technology will guide safe and secure healthcare information in the facility.